Effective time, correction speed and termination time of hemi-epiphysiodesis in children

In children with asymmetric growth on the medial and lateral side of limbs, if there still remains growth potential, the guided growth technique of hemi-epiphysiodesis on one side of the epiphysis is recognized as a safe and effective method. However, when the hemi-epiphysiodesis start to correct the deformities, how many degrees could hemi-epiphysiodesis bring every month and when to remove the hemi-epiphysiodesis implant without rebound phenomenon are still on debate. This article reviews the current studies focus on the effective time, correction speed and termination time of hemi-epiphysiodesis.

[Reunderstanding of atopic dermatitis in the elderly]

Atopic dermatitis (AD) is a highly heterogeneous skin disease. Many characteristics of AD in the elderly are different from those in other age groups, and AD in the elderly is prone to misdiagnosis or missed diagnosis, which has gradually gained recognition and attention in recent years. The onset of elderly AD is related to changes of aging related barrier and immune function. Elderly AD is more common in Th1 type of skin inflammation, and has certain "reverse" characteristics in clinical manifestations. The diagnosis of elderly AD should be based on exclusion diagnosis. In addition to the stepwise treatment, personalized treatment should also be made based on factors, such as skin characteristics and comorbidities of the elderly.

[Rosuvastatin acts on the lymphatic system to improve atherosclerosis]

Objective: To investigate whether rosuvastatin acts on lymphatic system and influences lymphatic system-mediated reverse cholesterol transport to play an anti-atherosclerosis role. Methods: Forty-eight apolipoprotein E^-/- mice fed a high fat diet were used to construct the atherosclerosis model. They were randomly divided into 4 groups with 12 rats in each group. They were treated with rosuvastatin, vascular endothelial growth factor-C (VEGF-C) and rosuvastatin+VEGF-C inhibitors as experimental group, and no intervention measures were given in control group. After 8 weeks, aortic plaque area, high density lipoprotein cholesterol (HDL-C) content in lymph fluid, the function of popliteal lymphatic drainage of peripheral Evans blue, and the ability of lymphatic system to transport peripheral cell membrane red fluorescent probes to label high-density lipoprotein (HDL) were detected. Subsequently, the effects of rosuvastatin on proliferation, migration and tubular function of lymphoendothelial cells and the expression of scavenger receptor class B type 1 (SR-B1) on lymphoendothelial cells at different concentrations were detected. Results: Compared with the control group, Rosuvastatin and VEGF-C could reduce the area of aortic atherosclerotic plaque (P<0.05). In addition to rosuvastatin plus VEGF-C inhibitor, the intra-aortic plaque area increased (P<0.05). Compared with the control group, Rosuvastatin could increase the content of HDL-C in lymphatic fluid (P<0.05), enhance the drainage function of lymphatic vessels, and enhance the capacity of HDL in the transport tissue fluid of lymphatic system. Compared with the control group, VEGF-C increased the content of HDL-C in mouse lymph fluid (P<0.01), enhanced the drainage function of popliteal lymphatic canal, and enhanced the ability of lymphatic system to transport HDL. With the addition of VEGF-C inhibitor on the basis of rosuvastatin, the content of HDL-C in lymph fluid was reduced, the drainage of popliteal lymphatic canal was interrupted, and the ability of lymphatic system to transport HDL was reduced. Western blotting showed that rosuvastatin increased the protein expression of SR-B1. Conclusion: Rosuvastatin can promote the proliferation, migration and tube formation of lymphatic endothelial cells. At the same time, SR-B1 expression on lymphatic endothelial cells is promoted, thus enhancing the lymphatic system mediated cholesterol reversal transport and playing the role of anti-atherosclerosis.

Diagnosis and treatment of chronic osteomyelitis based on nanomaterials

Chronic osteomyelitis is a painful and serious disease caused by infected surgical prostheses or infected fractures. Traditional treatment includes surgical debridement followed by prolonged systemic antibiotics. However, excessive antibiotic use has been inducing rapid emergence of antibiotic-resistant bacteria worldwide. Additionally, it is difficult for antibiotics to penetrate internal sites of infection such as bone, thus limiting their efficacy. New approaches to treat chronic osteomyelitis remain a major challenge for orthopedic surgeons. Luckily, the development of nanotechnology has brought new antimicrobial options with high specificity to infection sites, offering a possible way to address these challenges. Substantial progress has been made in constructing antibacterial nanomaterials for treatment of chronic osteomyelitis. Here, we review some current strategies for treatment of chronic osteomyelitis and their underlying mechanisms.

Post-traumatic heterotopic ossification in front of the ankle joint for 23 years: A case report and review of literature

BACKGROUND

Heterotopic ossification (HO) refers to the formation of new bone in non-skeletal tissues such as muscles, tendons or other soft tissues. Severe muscle and soft tissue injury often lead to the formation of HO. However, anterior HO of the ankle is rarely reported.

CASE SUMMARY

We report a patient with massive HO in front of the ankle joint for 23 years. In 1998, the patient was injured by a falling object on the right lower extremity, which gradually formed a massive heterotopic bone change in the right calf and dorsum of the foot. The patient did not develop gradual ankle function limitations until nearly 36 mo ago, and underwent resection of HO. Even after 23 years and resection of HO, the ankle joint was still able to move.

CONCLUSION

It is recommended that the orthopedist should be aware of HO and distinguish it from bone tumor.

Resumption of school after lockdown in COVID-19 pandemic: Three case reports

BACKGROUND

Students in the 9^th grade of junior high school in Changsha were under a 75 d lockdown due to the coronavirus disease 2019 (COVID-19) pandemic. After the resumption of school post-lockdown, the 9^th grade students in Changsha faced the entrance physical examination test for senior high school.

CASE SUMMARY

We report on 3 cases of occult fracture on the same site in adolescents of the same grade since resumption of school after the lockdown from the COVID-19 pandemic. Three students in the 9^th grade of junior high school who were facing the physical examination in 2 wk were diagnosed with an occult fracture of the distal femur.

CONCLUSION

It is recommended that the students, parents, education providers and policy makers should all pay attention to the physical exercise of students when the resumption of school after lockdown occurs and they should be aware of occult fractures when the adolescents have pain after physical exercise.

Synovial chondromatosis of the hip joint in a 6 year-old child: A case report

BACKGROUND

Synovial chondromatosis (SC) is a rare benign lesion first reported by Ambrose Pare in 1558. It is most common in the knee joint, followed by the hip joint and elbow joint. It is characterized by the presence of multiple pearl-like osteochondral bodies in the joint. The incidence in children is extremely low.

CASE SUMMARY

We report a 6-year-old Chinese boy who presented to our hospital with left hip joint pain and claudication for more than one year. We performed total surgical resection of SC tissue in the left hip. A good prognosis was confirmed at the 6-wk follow-up. Pain and swelling symptoms were totally relieved, range of motion of his left hip returned to normal, and there was no clinical evidence of lesion recurrence at last follow-up. Our case is the youngest reported patient with SC occurring in the hip.

CONCLUSION

SC is a rare disease and can be easily misdiagnosed. When we encounter children with hip pain and claudication, increased vigilance and a comprehensive physical examination and imaging examination should be considered, in order to avoid misdiagnosis and delayed treatment in patients.

[The exposure of antibiotics on the eradication of bismuth quadruple therapy in H.pylori infection]

Objective: To analyze the impact of previous exposure to macrolide, quinolones and nitroimidazole antibiotics on eradication rate of bismuth quadruple therapy (BQT) in newly diagnosed patients with Helicobacter pylori(H. pylori). Methods: A total of 469 patients with H. pylori initially treated at the Third Hospital of Peking University from September 2017 to August 2020 were retrospectively recruited. The therapeutic regimens were BQT containing clarithromycin/levofloxacin/metronidazole recommended by Chinese guidelines. Clinical data were collected, including general demographic data, exposure history of antibiotics, CYP2C16 metabolic pattern, endoscopic diagnosis, bacterial density, H.pylori resistance, eradication results, etc. Univariate analysis, Chi-square test, Fisher exact probability test, Kruskal-Wallis H test and Logistic regression model were used as statistical methods. Results: Among different eradication therapies, univariate and multivariate analyses suggested that previous exposure to macrolides (OR=3.37,95%CI 1.04-10.98, P<0.05) was relevant to the decreased eradication rate of BQT containing clarithromycin. This may be due to increased resistance to clarithromycin (OR=6.12,95%CI 3.99-9.40, P<0.01).The previous exposure to quinolones (OR=3.65, 95%CI 1.27-10.49, P<0.05) was relevant to the decreased eradication rate of BQT containing levofloxacin, which was probably explained by the increased resistance to levofloxacin (OR=2.50, 95%CI 1.69-3.71, P<0.01). But the previous history of nitroimidazole did not impact the efficacy of BQT containing metronidazole. Conclusions: In patients newly diagnosed with H.pylori infection, the previous exposure to macrolide or quinolones antibiotics is related to lower eradiation rates of H. pylori. Although the exposure to nitroimidazole also indicates drug resistance to metronidazole, the clinical efficacy of BQT with metronidazole 400 mg four times a day is not affected.

[An animal model of bladder reconstruction by autologous peritoneum transplantation]

Objective: To establish experimental porcine model of reconstruction the neobladder by ileal seromuscular with transplantation of autologous peritoneum. Methods: This was an animal experiment carried out from January to April 2018 at animal center of Guizhou Medical University. Randomly 6 experimental female porcines were chosen, and their body weight was 28 to 33 kg. By intravenous anesthesia, the transplantation of autologous peritoneum for bladder reconstruction operation was carried out by transplanting the peritoneum onto an ileum segment which mucosa and submucosa had been removed. These flaps were used to mend and reconstruct the neobladder by suturing with edge of the detective bladder. After removal of ureteral catheters and balloon catheter at day 5 and day 7 respectively, voiding behavior was monitored, and animals were euthanized at week 12 for routine pathology, immunohistochemistry, and electron microscopic examinations. Results: Six porcines underwent reconstruction, but no one lost to complications such as peritonitis, ileus and urinary fistula. Voiding behavior was normal, and urine was clear in all animals after removal of catheters. At autopsy, reconstructed bladders were healthy. Pathological examination showed the part of reconstruction had been covered by continuous urothelium while the peritoneum disappeared and showed no ileal mucosa regrowth and residual. Scanning electron microscope showed that the transitional cells of neobladder were complete and orderly, and urothelium around suture border was continuous and no malposition. Conclusion: In this experimental porcine model, reconstruction bladder by autologous peritoneum and ileal seromuscular flaps is an ideal approach.

Gene profiling involved in immature CD4+ T lymphocyte responsible for systemic lupus erythematosus

We attempted to characterize the genes expression of CD4+ T lymphocytes for the pathogenesis of systemic lupus erythematosus (SLE). Genomewide gene expression profiles of CD4+ T cells, which were isolated from the disease severe activity (T4-1s) and nonactivity (T4-2s) with an SLE patient by using long serial analysis of gene expression (LongSAGE). We picked out 289 genes matching to Unigene cluster with different expression more than four copies between T4-1s and T4-2s libraries and analyzed their roles from the collectedly published articles of PubMed by genes functional clustering. The genes functions were related to a diverse cellular process including: (1) most of these genes were associated with CD4+ T cells functions, particularly related to cellular developments; (2) Ras pathway genes as RANBP10, GMIP, RASGRP2 and ARL5 might be responsible for the abnormal development of CD4+ T cells of SLE; (3) HIG2, TCF7, KHSRP, WWP1, SMAD3, TLK2, AES, CCNI and PIM2 belong to Wnt/beta-catenin way, they could play roles in modulating proliferation and differentiation of T lymphocytes; (4) uncertain viral infections may initiate autoimmunity because high levels expression genes were detected in T4-1s such as TRIM22, IER2, ABCE1, DUT, G1P2, G1P3, HNRPUL1, EVER2, IFNAR1, TNFSF14, TMP21 and PVRL2; and (5) apoptosis relating genes as EIF3S8, SH3BGRL3, GPX4, TOSO, PFDN5, BIN1, XIAPAF1, TEGT and CUGBP2 may contribute to over uploading of selfantigens in SLE cells. Abnormalities findings of multiple genes expression involving with a variety of CD4+ T cells process might be meaningful to understanding the pathogenesis of SLE, and immature CD4+ T cells may be responsible for SLE.

Hepatitis C virus infection of human hepatoma cell line 7721 in vitro

AIM: To establish a cell culture system with long-term replication of hepatitis C virus in vitro.

METHODS: Human hepatoma cell line 7721 was tested for its susceptibility to HCV by incubating with a serum from a patient with chronic hepatitis C. Cells and supernatant were harvested at various phases during the culturing periods. The presence of HCV RNA, the expression of HCV antigens in cells and/or supernatant were examined by RT-PCR, in situ hybridization and immunohisto-chemistry respectively.

RESULTS: The intracellular HCV RNA was first detected on d2 after infection and then could be intermittently detected in both cells and supernatant over a period of at least three months. The expression of HCV NS₃, CP₁₀ antigens could be observed in cells. The fresh cells could be infected by supernatant from cultured infected cells and the transmission of viral genome from HCV-infected 7721 cells to PBMCs was also observed.

CONCLUSION: The hepatoma line 7721 is not only susceptible to HCV but also supports its long-term replication in vitro.

[Imaging diagnosis of cervical spondylosis]

Myodil-myelographic manifestations of 60 cases of cervical spondylotic myelopathy and radiculopathy were analyzed. For better understanding the biomechanical disturbances of cervical spondylosis, CT scans of 26 cases of this disease were also investigated. Myelography and/or CT were considered necessary if surgical procedure was to be undertaken with anterior approach. Myodil myelography or CT could fulfill the diagnostic requirements for surgery if Non-ionic water-soluble contrast media or other new techniques were not available.