A comparison of double single suture-button fixation,suture-button fixation,and screw fixation for ankle syndesmosis injury: A retrospective cohort study

Different methods have been used throughout the years for syndesmotic injury but there is no consensus on the ideal treatment. Some methods are expensive and some have more complications. The aim of this study is to compare single suture endobutton with double suture endobutton and screw fixation for syndesmotic injury.Sixty nine patients with syndesmotic injury with fibular fractures whom were treated with a single interosseous suture endobutton system (ZipTight^TM, Zimmer Biomet), a double interosseous suture endobutton system (ZipTight^TM, Zimmer Biomet) and 1 syndesmotic screw (TST, Istanbul, Turkey) were included in this study. Functional and radiological results from patient records between 2015 and 2018 were retrospectively evaluated.Twenty patients were treated with the double interosseous suture endobutton, 23 were treated with the single interosseous suture endobutton, and 26 were treated with traditional AO screw fixation. Three patients from the screw fixation group (11.5%) required revision surgery (P < .05). All the radiologic and clinical outcomes were statistical similar in all 3 groups.Our findings showed that the interosseous suture endobutton system is at least as safe as the screw fixation technique for treatment of syndesmosis joint injuries and can be used as an alternative to the screw method. The interosseous suture endobutton system eliminates the need for a second surgery to remove the hardware, which minimizes the probability of re-diastasis. Since our results showed no statistical difference between single and double interosseous suture endobutton systems, the less costly single endobutton system may be the better alternative.     

Giant right atrium and subvalvular pulmonary stenosis: A case report of an interesting combination

A 20‐year‐old Congolese woman presented with presyncope, dyspnea, and anasarca. Past medical history was unremarkable. Echocardiography revealed a rare combination of giant right atrium (RA), a dilated and hypertrophied right ventricle, subvalvular pulmonary stenosis (subPS), severe tricuspid regurgitation (TR), pericardial effusion and what appeared to be a spontaneously closed ventricular septal defect (VSD). Cardiac Magnetic Resonance and Cardiac Computed Tomography confirmed the findings excluding the presence of intra‐cardiac and extra‐cardiac shunt and other associated congenital anomalies. The patient underwent subPS resection, right atrioplasty, and tricuspid annuloplasty. Multimodality approach facilitated the detection of the abnormalities and provided clarity when determining the optimal surgical strategy.     

临床护理路径用于ICU重症颅脑损伤患者护理中的价值

目的 探讨临床护理路径用于ICU重症颅脑损伤患者护理中的价值。方法 选择2017年11月～2018年10月进行ICU重症颅脑损伤治疗的患者100例作为对象,随机数字表法分为对照组(n=50)和观察组(n=50)。对照组给予常规护理,观察组在其基础上应用临床护理路径,15 d护理后比较患者依从性情况、对患者护理前后心理状态进行评分,对不良并发症产生情况进行比较。结果 观察组康复锻炼依从、按时用药依从及饮食依从高于对照组(P0.05)。护理前两组SDS与SAS评分比较差异无统计学意义(P0.05),护理后,观察组SDS与SAS评分低于对照组(P0.05)。观察组出现压疮、泌尿感染、以及发热的发生率显著低于对照组(P0.05)。结论 将临床护理路径用于ICU重症颅脑损伤患者的护理中,提高了患者的护理依从性,减少了不良情绪以及不良并发症的产生,有助于患者整体治疗,值得推广应用。     

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??Objective    To investigate the characteristics of indirect injury of periodontal membrane caused by maxillofacial impact injury. Methods    The study was carried out at the laboratory of oral and maxillofacial trauma in Fourth Military Medical University??from November 2013 to January 2014. Totally 18 dogs were divided equally into six groups with random allocation??the right mandible of each dog was impacted by a cylindroid iron cap whose weight was 0.26kg??but teeth were not injured directly??the animals were killed 6 h??24 h??3 d??7 d??2 wk and 4 wk later??respectively??the histopathologic manifestations of periodontal membrane of the fourth premolar of right mandible??the second premolar of right mandible and the second premolar of left mandible were observed. Results    The injury of periodontal membrane of the fourth premolar of right mandible was relatively obvious??but the pathologic changes were reversible??periodontal membrane of the second premolar of right mandible was injured slightly??yet no obvious histopathologic change could be observed in periodontal membrane of the second premolar of left mandible. Conclusion    Maxillofacial impact injury can cause indirect injuries of periodontal membrane of adjacent teeth??but the pathologic changes are reversible??traumatic severity decreases as the distance of the tooth to the wound area increases.     

活血利水法在骨伤科疾病中的应用

基于骨伤疾病瘀血内阻的重要病机和现代医家"治血重治水"的学术观点,探索概括了活血利水法在骨伤疾病中的应用现状,结合现代医学的认识,全方位分析了活血利水法的优势和缺点。活血利水法可应用于骨折、筋伤等骨伤科大部分疾病及骨伤科疾病的围手术期,能改善肢体肿胀,促进伤口愈合,便于患者早期功能康复,但目前的临床应用尚缺乏统一的规范和标准,且处方不良反应尚未完全阐明。     

Deficiency of anti-inflammatory cytokine IL-4 leads to neural hyperexcitability and aggravates cerebral ischemia–reperfusion injury

Systematic administration of anti-inflammatory cytokine interleukin 4 (IL-4) has been shown to improve recovery after cerebral ischemic stroke. However, whether IL-4 affects neuronal excitability and how IL-4 improves ischemic injury remain largely unknown. Here we report the neuroprotective role of endogenous IL-4 in focal cerebral ischemia–reperfusion (I/R) injury. In multi-electrode array (MEA) recordings, IL-4 reduces spontaneous firings and network activities of mouse primary cortical neurons. IL-4 mRNA and protein expressions are upregulated after I/R injury. Genetic deletion of Il-4 gene aggravates I/R injury in vivo and exacerbates oxygen-glucose deprivation (OGD) injury in cortical neurons. Conversely, supplemental IL-4 protects Il-4^−/− cortical neurons against OGD injury. Mechanistically, cortical pyramidal and stellate neurons common for ischemic penumbra after I/R injury exhibit intrinsic hyperexcitability and enhanced excitatory synaptic transmissions in Il-4^−/− mice. Furthermore, upregulation of Nav1.1 channel, and downregulations of KCa3.1 channel and α6 subunit of GABA_A receptors are detected in the cortical tissues and primary cortical neurons from Il-4^−/− mice. Taken together, our findings demonstrate that IL-4 deficiency results in neural hyperexcitability and aggravates I/R injury, thus activation of IL-4 signaling may protect the brain against the development of permanent damage and help recover from ischemic injury after stroke.     

Is dose modification or discontinuation of nilotinib necessary in nilotinib-induced hyperbilirubinemia?

Nilotinib is a specific breakpoint cluster region-Abelson leukemia virus-tyrosine kinase inhibitor that is used as an effective first- or second-line treatment in imatinib-resistant chronic myelogenous leukemia (CML) patients. Hepatotoxicity due to nilotinib is a commonly reported side effect; however, abnormal liver function test (LFT) results have been reported in asymptomatic cases. When alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels are more than five-fold the upper limit of the normal (ULN) or when the serum total bilirubin level is more than three-fold the ULN, dose modification or discontinuation of nilotinib is recommended, resulting in decreased levels of hematological indicators in certain patients with CML. Nilotinib-induced hyperbilirubinemia typically manifests as indirect bilirubinemia without elevated ALT or AST levels. Such abnormal liver functioning is thus not attributed to the presence of a true histologic lesion of the liver. The underlying mechanism may be related to the inhibition of uridine diphosphate glucuronosyltransferase activity. Therefore, nilotinib dose adjustment is not recommended for this type of hyperbilirubinemia, and in the absence of elevated liver enzyme levels or presence of abnormal LFT findings, physicians should consider maintaining nilotinib dose intensity without modifications.     

Recipient hypertonic saline infusion prevents cardiac allograft dysfunction

Objective

Hypertonic saline (HTS) has potent immune and vascular effects. We assessed recipient pretreatment with HTS on allograft function in a porcine model of heart transplantation and hypothesized that HTS infusion would limit endothelial and left ventricular (LV) dysfunction following transplantation.

Clinical equivalence assessment of T2 synthesized pediatric brain magnetic resonance imaging

Background and purposeAutomated synthetic magnetic resonance imaging (MRI) provides qualitative, weighted image contrasts as well as quantitative information from one scan and is well-suited for various applications such as analysis of white matter disorders. However, the synthesized contrasts have been poorly evaluated in pediatric applications. The purpose of this study was to compare the image quality of synthetic T2 to conventional turbo spin-echo (TSE) T2 in pediatric brain MRI.Materials and methodsThis was a mono-center prospective study. Synthetic and conventional MRI acquisitions at 1.5 Tesla were performed for each patient during the same session using a prototype accelerated T2 mapping sequence package (TA_synthetic = 3:07 min, TA_conventional = 2:33 min). Image sets were blindly and randomly analyzed by pediatric neuroradiologists. Global image quality, morphologic legibility of standard structures and artifacts were assessed using a 4-point Likert scale. Inter-observer kappa agreements were calculated. The capability of the synthesized contrasts and conventional TSE T2 to discern normal and pathologic cases was evaluated.ResultsSixty patients were included. The overall diagnostic quality of the synthesized contrasts was non-inferior to conventional imaging scale (P = 0.06). There was no significant difference in the legibility of normal and pathological anatomic structures of synthetized and conventional TSE T2 (all P > 0.05) as well as for artifacts except for phase encoding (P = 0.008). Inter-observer agreement was good to almost perfect (kappa between 0.66 and 1).ConclusionsT2 synthesized contrasts, which also provides quantitative T2 information that could be useful, could be suggested as an equivalent technique in pediatric neuro-imaging, compared to conventional TSE T2.