Mini-midvastus versus mini-medial parapatellar approach in total knee arthroplasty: a prospective, randomized study

Introduction

To date, no English literature has evaluated the short-term results of the mini-medial parapatellar approach compared with the mini-midvastus approach. This prospective, randomized study was performed to compare the short-term results of total knee arthroplasty using either a mini-midvastus or a mini-medial parapatellar approach.

Patients and methods

We reported the clinical and radiological results of 89 patients who had primary total knee arthroplasties with minimally invasive techniques using either a mini-midvastus or a mini-medial parapatellar approach. The mini-midvastus approach was used on 45 patients (group I) and a mini-medial parapatellar approach on 44 patients (group II). Skin incision length, tourniquet time, incidence of lateral retinacular release, total blood loss, straight leg raising time, visual analogy scale score, alignment of the knee, component position, and complication of each group were examined. Knee Society scores, range of motion were compared at 7 days, 6 weeks, 3 months, and 6 months postoperatively.

Results

The mean tourniquet time was 68 min in group I, significantly longer than 56 min for group II. However, comparisons of postoperative knee scores and function scores between both approaches did not yield a significant difference in outcome. No significant difference was found with respect to total blood loss, visual analogy scale score, straight-leg-raising test, range of motion or radiographic findings.

Conclusion

Based on these results, we believe that the early results are similar between mini-midvastus and mini-medial parapatellar approach, ultimately the selection of the surgical approach will depend on the surgeon’s experience and preference.     

Evaluation of global DNA hypomethylation in human prostate cancer and prostatic intraepithelial neoplasm tissues by immunohistochemistry

ObjectiveTo identify the differences of 5-methylcytosine (5-MC) level between primary prostate cancer tissues (PCTs), prostate cancer-adjacent benign tissues (PCABTs), low-grade prostatic intraepithelial neoplasia (LGPIN), and high-grade prostatic intraepithelial neoplasia (HGPIN), and further analysis the 5-MC alterations in prostate cancer with pathologic grade and clinical prognosis.Materials and methodsImmunohistochemistry method with a 5-MC monoclonal antibody was used to identify the 5-methylcytosine (5-MC) levels in PCTs, PCABTs, LGPIN, and HGPIN specimens in the present study. Statistical analysis with SPSS software (SPSS Inc., Chicago, IL) was used to compare differences of 5-MC levels in the four groups and evaluate the 5-MC alterations in prostate cancer with pathologic grade and clinical prognosis.ResultsWe found that 38 of 48 (79.1%) patients studied showed a decrease in 5-MC staining of PCTs compared with PCABTs. The difference in the methylation levels for the PCTs and the PCABTs was highly statistically significant (P < 0.001). Spearman correlation showed there was no statistically significant association between the average score of 5-MC staining and Gleason score sum. Kaplan-Meier survival analysis showed that patient group with no or weak 5-MC staining compared with group with moderate and strong 5-MC staining was associated with better survival of patients, although there was no statistically significant difference between the 2 groups in predicating prognosis (P = 0.385). The average scores of 5-MC staining for LGPIN, HGPIN, PCABTs, and PCTs groups were 6.91, 1.58, 6.63, and 3.10, respectively. The methylation level of HGPIN group, as well as that of PCTs group, was significantly lower than those of LGPIN (P < 0.001; P < 0.001) and PCABTs groups (P < 0.001; P < 0.001), respectively, with the 5-MC levels of PCABTS group similar to that of LGPIN group (P = 0.476). 5-MC levels of HGPIN group was lower than that PCTs group (P = 0.004).ConclusionsWe found that global DNA methylation was low in most prostate cancer compared with benign regions from the same patient's sections. None of the DNA hypomethylation changes in primary cancers were associated with pathologic grade and clinical prognosis. In addition, immunohistochemistry showed that the global methylation was lower in HGPIN compared with LGPIN and methylcytosine staining in HGPIN was lower than that of PCTs. The results suggest that global DNA hypomethylation might play an important role in the process of prostate cancer initiation rather than progression.     

Successful Use of Platelet-Rich Plasma for Chronic Plantar Fasciitis

Background:

There are limited data on the use of platelet-rich plasma (PRP) for treating chronic plantar fasciitis.

Questions/Purposes:

The purpose of this study was to document the clinical outcomes of patients who were treated with PRP injections for plantar fasciitis to determine the degree to which injections were able to decrease the visual analogue scale (VAS) pain scores and improve patient reported functional scores.

Methods:

This was a retrospective review of 23 consecutive patients treated with PRP for chronic plantar fasciitis (symptoms lasting over 6 months). Patients returned after 4 weeks for a postinjection follow-up. A second injection was given if significant improvement was not obtained by that time. Postinjection foot and ankle outcome scores (FAOS), 12-item short form health survey (SF-12), and VAS scores were collected at a minimum of 6 months follow-up.

Results:

Thirty injections were given in 23 patients, with one patient lost to follow-up. The mean VAS score improved from 7 to 4. The pain, symptoms, and quality of life subscales of the FAOS and SF-12 significantly improved from preinjection scores. Five patients went on to have endoscopic release of the plantar fascia at an average of 94 days after the last injection (range, 22–314 days). Six patients obtained full resolution of symptoms while the majority of patients were able to forgo surgery due to improvement from the PRP injection.

Conclusion:

These results provide preliminary information on the safety and efficiency of PRP injection as treatment for chronic plantar fasciitis.

Electronic supplementary material

The online version of this article (doi:10.1007/s11420-012-9321-9) contains supplementary material, which is available to authorized users.     

Biologic Fixation through Bridge Plating for Comminuted Shaft Fracture of the Clavicle: Technical Aspects and Prospective Clinical Experience with a Minimum of 12-Month Follow-up

For comminuted shaft fracture of clavicle, the operative goal, aside from sound bone healing without complications of direct reduction, is maintenance of the original length in order to maintain the normal biomechanics of adjacent joint. Our bridge plating technique utilizing distraction through a lumbar spreader was expected to be effective for restoring clavicular length with soft tissue preservation. However, there are two disadvantages. First, there is more exposure to radiation compared to conventional plating; and second, it is difficult to control the rotational alignment. Despite these disadvantages, our technique has important benefits, in particular, the ability to preserve clavicular length without soft tissue injury around the fracture site.     

Intrathecal injection of dexmedetomidine ameliorates chronic neuropathic pain via the modulation of MPK3/ERK1/2 in a mouse model of chronic neuropathic pain

ABSTRACT

Objective: Despite the application of dexmedetomidine (DEX) as a perioperative adjuvant in local analgesia, the exact analgesic mechanism underpinning chronic neuropathic pain (CNP) awaits our elucidation.

Methods: We investigated the molecular mechanisms of the anti-nociceptive effect of DEX on neuropathic pain in a mouse model induced by chronic constriction injury (CCI).

Results: DEX administration significantly increased the paw withdrawal latency (PWL) values 0.5 to 2 h post-injection in CCI-induced CNP mice at day 5 to 21 versus dimethyl sulfoxide (DMSO)-treated mice, confirming its analgesic effect. The c-Fos expression was significantly elevated in CCI mice versus the sham-operated group, whereas the elevation was mitigated by DEX injection. Subsequently, the involvement of MKP1 and MKP3 in the pathogenesis of chronic neuropathic pain was evaluated. Western blotting analyses revealed significant decrease in both MKP1 and MKP3 in the spinal cord in CCI group versus the sham group. DEX markedly elevated the MKP3 expression and modestly reduced the MKP1 expression, with insignificant difference in the latter. Co-injection of BCI (an MKP3 inhibitor) and DEX evidently reduced the PWL values in CCI mice. Furthermore, DEX significantly downregulated the phosphorylation of extracellular-signal-regulated kinase (ERK) 1/2, down-stream effector of MKP3 in CCI mice, whereas the downregulation was reversed by BCI.

Conclusion: We confirmed that DEX exerts the analgesic effect on chronic neuropathic pain via the regulation of MKP3/ERK1/2 signaling pathway, which may contribute to clarification of the molecular mechanism and novel therapy for chronic neuropathic pain.     

Rapid visual stimulation increases extrasynaptic glutamate receptor expression but not visual‐evoked potentials in the adult rat primary visual cortex

The model most used to study synaptic plasticity, long‐term potentiation (LTP), typically employs electrical stimulation of afferent fibers to induce changes in synaptic strength. It would be beneficial for understanding the behavioral relevance of LTP if a model could be developed that used more naturalistic stimuli. Recent evidence suggests that the adult visual cortex, previously thought to have lost most of its plasticity once past the critical period, is in fact capable of LTP‐like changes in synaptic strength in response to sensory manipulations alone. In a preliminary study, we used a photic tetanus (PT; flashing checkerboard stimulus) to induce an enhancement of the visual‐evoked potential (VEP) in the primary visual cortex of anesthetised adult rats. In the present study, we sought to compare the mechanisms of this novel sensory LTP with those of traditional electrical LTP. Unexpectedly, we found that sensory LTP was not induced as reliably as we had observed previously, as manipulations of several parameters failed to lead to significant potentiation of the VEP. However, we did observe a significant increase in visual cortex glutamate receptor expression on the surface of isolated synapses following the PT. Both AMPA receptor expression and N‐methyl‐d ‐aspartate (NMDA) receptor subunit expression were increased, specifically in extrasynaptic regions of the membrane, in PT animals. These results provide biochemical confirmation of the lack of change in the VEP in response to PT, but suggest that PT may prime synapses for strengthening upon appropriate subsequent activation, through the trafficking of glutamate receptors to the cell surface.     

Spinocerebellar ataxia 17: Inconsistency between phenotype and neuroimage findings

Spinocerebellar ataxia 17 (SCA17) is an autosomal dominant neurodegenerative disease clinically characterized by the presence of cerebellar ataxia in combination with variable neurological symptoms. Here we report a Chinese SCA17 family which proband''s clinical manifestation was inconsistent with the neuroimage findings.Key Words: Neuroimage, spinocerebellar ataxia 17, TATA-box binding protein gene, trinucleotide repeat     

The ex-Gaussian distribution of reaction times in adolescents with attention-deficit/hyperactivity disorder

We investigated the three parameters (mu, sigma, tau) of ex-Gaussian distribution of RT derived from the Conners’ continuous performance test (CCPT) and examined the moderating effects of the energetic factors (the inter-stimulus intervals (ISIs) and Blocks) among these three parameters, especially tau, an index describing the positive skew of RT distribution. We assessed 195 adolescents with DSM-IV ADHD, and 90 typically developing (TD) adolescents, aged 10–16. Participants and their parents received psychiatric interviews to confirm the diagnosis of ADHD and other psychiatric disorders. Participants also received intelligence (WISC-III) and CCPT assessments. We found that participants with ADHD had a smaller mu, and larger tau. As the ISI/Block increased, the magnitude of group difference in tau increased. Among the three ex-Gaussian parameters, tau was positively associated with omission errors, and mu was negatively associated with commission errors. The moderating effects of ISIs and Blocks on tau parameters suggested that the ex-Gaussian parameters could offer more information about the attention state in vigilance task, especially in ADHD.     

Dynamic Changes of Jab1 and p27kip1 Expression in Injured Rat Sciatic Nerve

Jun activation domain-binding protein (Jab1) is a multifunctional protein that participates in affecting signaling pathway, controlling cell proliferation and apoptosis, and regulating genomic instability and DNA repair, and acts as a key subunit of COP9 signalosome. p27kip1, a member of the Cip/Kip family of cyclin-dependent kinase inhibitors, was shown to inhibit the enzymatic activity of cyclin–CDK complexes, resulting in cell-cycle arrest at G₁. Recent studies have shown that Jab1 directly binds to p27kip1 and induces nuclear export and subsequent degradation in a variety of human cancers, while the association and function of Jab1 and p27kip1 in nervous system lesion and regeneration remain unclear. Here, we performed a sciatic nerve injury model in adult rats and studied the dynamic changes of Jab1 and p27kip1 expression by Western blot. Sciatic nerve crush (SNC) resulted in a significant upregulation of Jab1 and a downregulation of p27kip1. Besides, we observed that Jab1 was expressed widely in Schwann cells (SCs) and had few co-localization in axons by double immunofluorescence staining. In addition, the peak expression of Jab1 was parallel with proliferating cell nuclear antigen (PCNA), and numerous SCs expressing Jab1 were PCNA-positive. Results obtained by co-immunoprecipitation and double labeling further showed their interaction in the sciatic nerve. Thus, these results suggested that Jab1 and p27kip1 may be involved in the pathophysiology of sciatic nerve after SNC.