BACKGROUND Avulsion fracture of the ischial tuberosity is a relatively clinically rare type of trauma that is mainly incurred by adolescents during competitive sports activities.According to previous literature,the mo...BACKGROUND Avulsion fracture of the ischial tuberosity is a relatively clinically rare type of trauma that is mainly incurred by adolescents during competitive sports activities.According to previous literature,the most commonly involved sports are soccer,sprinting,and gymnastics,in descending order.Dance-induced avulsion fracture of the ischial tuberosity and ischial ramus is extremely clinically rare.CASE SUMMARY A case of a neglected avulsion fracture of the ischial tuberosity and ischial ramus was diagnosed in a young female dancer who complained of pain and restricted movement of her right hip.She stated that she had suffered the injury while performing a split leap during a dance performance 9 mo prior.Eventually,she underwent surgery and obtained satisfactory treatment results.CONCLUSION Early diagnosis of these fractures is important to ensuring early proper treatment towards a quicker recovery.For old fractures with nonunion and chronic buttock pain,surgery is a preferred therapeutic choice with good treatment outcomes.展开更多
Channel avulsion is a natural phenomenon that occurs abruptly on alluvial river deltas,which can affect the channel stability.The causes for avulsion could be generally categorized as topography-and flood-driven facto...Channel avulsion is a natural phenomenon that occurs abruptly on alluvial river deltas,which can affect the channel stability.The causes for avulsion could be generally categorized as topography-and flood-driven factors.However,previous studies on avulsion thresholds usually focused on topography-driven factors due to the centurial or millennial avulsion timescales of the world’s most deltas,but neglected the impacts of flood-driven factors.In the current study,a novel demarcation equation including the two driven factors was proposed,with the decadal timescale of avulsion being considered in the Yellow River Estuary(YRE).In order to quantify the contributions of different factors in each category,an entropy-based methodology was used to calculate the contributing weights of these factors.The factor with the highest weight in each category was then used to construct the demarcation equation,based on avulsion datasets associated with the YRE.An avulsion threshold was deduced according to the demarcation equation.This avulsion threshold was then applied to conduct the risk assessment of avulsion in the YRE.The results show that:two dominant factors cover respectively geomorphic coefficient representing the topography-driven factor and fluvial erosion intensity representing the flood-driven factor,which were thus employed to define a two dimensional mathematical space in which the demarcation equation can be obtained;the avulsion threshold derived from the equation was also applied in the risk assessment of avulsion;and the avulsion threshold proposed in this study is more accurate,as compared with the existing thresholds.展开更多
BACKGROUND Given its size and location,the liver is the third most injured organ by abdominal trauma.Thanks to recent advances,it is unanimously accepted that the nonoperative management is the current mainstay of tre...BACKGROUND Given its size and location,the liver is the third most injured organ by abdominal trauma.Thanks to recent advances,it is unanimously accepted that the nonoperative management is the current mainstay of treatment for hemodynamically stable patients.However,those patients with hemodynamic instability that generally present with severe liver trauma associated with major vascular lesions will require surgical management.Moreover,an associated injury of the main bile ducts makes surgery compulsory even in the case of hemodynamic stability,thereby imposing therapeutic challenges in the tertiary referral hepato-biliopancreatic centers’setting.CASE SUMMARY We present the case of a 38-year-old male patient with The American Association for the Surgery of Trauma grade V liver injury and an associated right branch of portal vein and common bile duct avulsion,due to a crush polytrauma.The patient was referred to the nearest emergency hospital and because of the hemorrhagic shock,damage control surgery was performed by means of ligation of the right portal vein branch and right hepatic artery,and hemostatic packing.Afterwards,the patient was referred immediately to our tertiary hepato-bilio-pancreatic center.We performed depacking,a right hepatectomy and Roux-en-Y hepaticojejunostomy.On the 9th postoperative day,the patient developed a high output anastomotic bile leak that required a redo of the cholangiojejunostomy.The postoperative period was marked by a surgical incision site of incomplete evisceration that was managed non-operatively by negative wound pressure.The follow-up was optimal,with no complications at 55 mo.CONCLUSION In conclusion,the current case clearly supports that a favorable outcome in severe liver trauma with associated vascular and biliary injuries is achieved thru proper therapeutic management,conducted in a tertiary referral hepato-bilio-pancreatic center,where a stepwise and complex surgical approach is mandatory.展开更多
BACKGROUNDHip avulsion fractures occur mostly during adolescence when actions such askicking or running cause forceful contraction of attached muscle.Osteochondroma is benign tumor that mostly occurs at the metaphysis...BACKGROUNDHip avulsion fractures occur mostly during adolescence when actions such askicking or running cause forceful contraction of attached muscle.Osteochondroma is benign tumor that mostly occurs at the metaphysis of a longbone, being usually asymptomatic.CASE SUMMARYA 15-year-old patient experienced feeling and sound of a break while kicking aball in soccer game three years prior to his visit to our hospital. A simple X-rayrevealed an avulsion fracture of the apophysis of the anterior inferior iliac spine(AIIS). Later in the follow-up X-ray, a palpable mass was found and demonstratedby magnetic resonance imaging to be a pedunculated osteochondroma in thesuperolateral aspect of the AIIS. For surgical treatment, we performed osteotomyfor surgical excision and excisional biopsy. A mass with smooth surface and anunclear superolateral AIIS border was found intraoperatively. Pathologic examshowed definite diagnosis of osteochondroma. Postoperatively, discomfort duringhip flexion was improved, and the hip joint range of motion during walking wasrecovered at the last follow-up, which was three weeks after the surgery.CONCLUSIONThis is a rare case to demonstrate relevant previous trauma history prior to theformation of osteochondroma.展开更多
Brachial plexus avulsion often results in massive motor neuron death and severe functional deficits of target muscles. However, no satisfactory treatment is currently available. Hypoxia-inducible factor 1α is a criti...Brachial plexus avulsion often results in massive motor neuron death and severe functional deficits of target muscles. However, no satisfactory treatment is currently available. Hypoxia-inducible factor 1α is a critical molecule targeting several genes associated with ischemia-hypoxia damage and angiogenesis. In this study, a rat model of brachial plexus avulsion-reimplantation was established, in which C5–7 ventral nerve roots were avulsed and only the C6 root reimplanted. Different implants were immediately injected using a microsyringe into the avulsion-reimplantation site of the C6 root post-brachial plexus avulsion. Rats were randomly divided into five groups: phosphate-buffered saline, negative control of lentivirus, hypoxia-inducible factor 1α(hypoxia-inducible factor 1α overexpression lentivirus), gel(pluronic F-127 hydrogel), and gel + hypoxia-inducible factor 1α(pluronic F-127 hydrogel + hypoxia-inducible factor 1α overexpression lentivirus). The Terzis grooming test was performed to assess recovery of motor function. Scores were higher in the hypoxia-inducible factor 1α and gel +hypoxia-inducible factor 1α groups(in particular the gel + hypoxia-inducible factor 1α group) compared with the phosphate-buffered saline group. Electrophysiology, fluorogold retrograde tracing, and immunofluorescent staining were further performed to investigate neural pathway reconstruction and changes of neurons, motor endplates, and angiogenesis. Compared with the phosphate-buffered saline group, action potential latency of musculocutaneous nerves was markedly shortened in the hypoxia-inducible factor 1α and gel + hypoxia-inducible factor1α groups. Meanwhile, the number of fluorogold-positive cells and ChAT-positive neurons, neovascular area(labeled by CD31 around av ulsed sites in ipsilateral spinal cord segments), and the number of motor endplates in biceps brachii(identified by α-bungarotoxin) were all visibly increased, as well as the morphology of motor endplate in biceps brachil was clear in the hypoxia-inducible factor 1α and gel + hypoxia-inducible factor 1α groups. Taken together, delivery of hypoxia-inducible factor 1α overexpression lentiviral vectors mediated by pluronic F-127 effectively promotes spinal root regeneration and functional recovery post-brachial plexus avulsion. All animal procedures were approved by the Institutional Animal Care and Use Committee of Guangdong Medical University, China.展开更多
BACKGROUND The tibial stop of anterior cruciate ligament(ACL) is fan-shaped and attached to the medial groove in front of the intercondylar spine,which is located between the anterior horn of the medial and lateral me...BACKGROUND The tibial stop of anterior cruciate ligament(ACL) is fan-shaped and attached to the medial groove in front of the intercondylar spine,which is located between the anterior horn of the medial and lateral meniscus.The incidence of this fracture is low previously reported,which is common in children and adolescents.With the increase of sports injury and traffic injury and the deepening of understanding,it is found that the incidence of the disease is high at present.AIM To explore the difference between open reduction and internal fixation with small incision and high-intensity non-absorbable suture under arthroscopy in the treatment of tibial avulsion fracture of ACL.METHODS Seventy-six patients with tibial avulsion fracture of anterior cruciate ligament diagnosed and treated in Guanyun County People’s Hospital from April 2018 to June 2020 were retrospectively analyzed.According to the surgical methods,they were divided into group A(40 cases) and group B(36 cases).Patients in group A were treated with arthroscopic high-strength non-absorbable suture,and patients in group B were treated with small incision open reduction and internal fixation.The operation time,fracture healing time,knee joint activity and functional score before and after operation,and surgical complications of the two groups were compared.RESULTS The operation time of group A was higher than that of group B,and the difference was statistically significant(P < 0.05);the fracture healing time of group A was compared with that of group B,and the difference was not statistically significant(P > 0.05);The knee joint function activity was compared between two groups before operation,3 mo and 6 mo after operation,and the difference was not statistically significant(P > 0.05);the knee joint function activity of group A and group B at 3 mo and 6 mo after operation was significantly higher than that before operation(P < 0.05);the limp,support,lock,instability,swelling,upstairs,squatting,pain and Lysholm score were compared between the two groups before and 6 mo after operation,and the difference was not statistically significant(P > 0.05);the scores of limp,support,lock,instability,swelling,upstairs,squatting,pain and Lysholm in group A and group B at 6 mo after operation were significantly higher than those before operation(P > 0.05);the surgical complication rate of group A was 2.63%,which was lower than 18.42% of group B,and the difference was statistically significant(P > 0.05).CONCLUSION Both small incision open reduction and internal fixation and arthroscopic high-strength nonabsorbable sutures can achieve good results in the treatment of anterior cruciate ligament tibial avulsion fractures.The operation time of arthroscopic high-strength non-absorbable sutures is slightly longer,but the complication rate is lower.展开更多
BACKGROUND Independent avulsion fractures with anterior cruciate ligament(ACL)or posterior cruciate ligament(PCL)attachment are relatively common among tibial intercondylar eminence fractures,and their postoperative o...BACKGROUND Independent avulsion fractures with anterior cruciate ligament(ACL)or posterior cruciate ligament(PCL)attachment are relatively common among tibial intercondylar eminence fractures,and their postoperative outcomes are generally favorable.Conversely,huge avulsion fractures of the intercondylar eminence containing the attachment site of both the ACL and the PCL are extremely rare,and the reported clinical outcomes are poor.CASE SUMMARY We describe a 30-year-old Japanese male's huge avulsion fracture of the intercondylar eminence of a tibia containing the attachment site of both the ACL and PCL,together with a complete tear of the medial collateral ligament and a partial tear of both the medial and lateral menisci caused by a fall from a high place.All of these injuries were treated surgically,with anatomical reduction and stable fixation.The limb function at 1 year post-surgery was excellent(Lysholm score:100 points).CONCLUSION Although this patient's complete surgical repair was complex,it should be performed in similar cases for an excellent final clinical outcome.展开更多
BACKGROUND Few cases of avulsion fractures of the tibial tuberosity with simultaneous rupture of the patellar tendon have been reported in the literature.Therefore,its mechanism and incidence have not been determined ...BACKGROUND Few cases of avulsion fractures of the tibial tuberosity with simultaneous rupture of the patellar tendon have been reported in the literature.Therefore,its mechanism and incidence have not been determined conclusively.This type of fracture is considered a serious injury that requires prompt diagnosis and early surgical repair.There is no therapeutic algorithm or standard method of treatment due to the infrequency of the injury.In this case report,we conducted an exhaustive review and synthesis of the existing literature including all previously reported cases.CASE SUMMARY We present a 16-year-old male soccer player with a case of a tibial tuberosity fracture with distal avulsion of the patellar tendon 5 d prior to surgical treatment.The patient presented with a loss of the extensor mechanism of the knee,edema,the inability to walk,and pain.X-rays showed a high patella and a 180-degree avulsion of the tibial tuberosity.The diagnosis was confirmed by magnetic resonance imaging and computed tomography.The patient underwent open reduction and internal fixation of the fracture with a cannulated screw and washer as well as patellar tendon repair with two metallic anchors.The rehabilitation protocol consisted of initial immobilization in extension followed by passive mobility and muscle strengthening exercises.The patient demonstrated excellent postoperative outcomes and returned to regular activity without complications.CONCLUSION This case presentation and literature review comprise the most relevant clinical,radiographic,and treatment details described in the international literature to date,providing the reader with an overview of this rare condition.展开更多
BACKGROUND Ureteroscopy is well-established as a primary treatment modality for urolithiasis.Ureteral avulsion,particularly complete or full-length avulsion with a resultant long segment of the ureter left attached to...BACKGROUND Ureteroscopy is well-established as a primary treatment modality for urolithiasis.Ureteral avulsion,particularly complete or full-length avulsion with a resultant long segment of the ureter left attached to the ureteroscope,is a rare but devastating complication of the procedure.Management of this complication is challenging.Moreover,general consensus regarding the optimal management is undetermined.We report our experience of managing a complete ureteral avulsion case via an extended Boari flap technique with long-term results.CASE SUMMARY A 41-year-old female patient subjected to complete ureteral avulsion caused by ureteroscopy was referred to our hospital.A modified,extended Boari flap technique was successfully performed to repair the full-length ureteral defect.Maximal mobilization of the bladder and affected kidney followed by psoas hitch and downward nephropexy maximized the probability of a tension-free anastomosis.Meticulous blood supply preservation to the flap also contributed to the success.During the 4-year study period,no complications except for a mild urinary frequency and a slightly lower maximum urinary flow rate were reported.The patient was satisfied with the surgical outcomes.CONCLUSION The extended Boari flap procedure is a feasible and preferred technique to manage complete ureteral avulsion,particularly in emergencies.展开更多
The Huron River consists of alternating bedrock reaches and alluvial reaches. Analysis of historical aerial photography from 1950-2015 reveals six major channel avulsion events in the 8-km study area. These avulsions ...The Huron River consists of alternating bedrock reaches and alluvial reaches. Analysis of historical aerial photography from 1950-2015 reveals six major channel avulsion events in the 8-km study area. These avulsions occurred in the alluvial reaches but were strongly influenced by the properties of the upstream bedrock reach (“inherited characteristics”). The bedrock reaches aligned with the azimuth of joint sets in the underlying bedrock. One inherited characteristic in the alluvial reach downstream is that the avulsion channels diverged only slightly from the orientation of the upstream bedrock channel (range 2 °- 38 °, mean and standard deviation 12.1 °± 13.7 °). A second inherited characteristic is that avulsion channels were initiated from short distances downstream after exiting the upstream bedrock channel reach (range 62 - 266 m, mean and standard deviation 143.7 ± 71.0 m), which is a fraction of the meander wavelength (1.2 km). Field evidence shows that some avulsion channel sites were re-occupied episodically. In addition, two properties were necessary for channel avulsions: 1) avulsion events were triggered by channel-forming hydrologic events (5-year recurrence interval flows), but not every channel-forming hydrologic event resulted in an avulsion, and 2) channel sinuosity (P) increased to 1.72 - 1.77 prior to an avulsion then decreased to 1.65 - 1.70 following an avulsion, suggesting that P ≥ 1.72 is the “critical sinuosity” or triggering value for avulsions on the Huron River. In summary, for this river consisting of alternating bedrock and alluvial reaches, the bedrock reaches impose certain parameters on downstream alluvial reaches (including sediment supply, channel direction and avulsion channel position downstream after exiting a bedrock reach) while adjustments in sinuosity and sediment storage occur in the alluvial reaches.展开更多
Posterior hip dislocation with greater trochanter fracture is an uncommon injury pattern in the acute trauma patient. Frequently associated injury includes a combination of hip dislocation with posterior wall of aceta...Posterior hip dislocation with greater trochanter fracture is an uncommon injury pattern in the acute trauma patient. Frequently associated injury includes a combination of hip dislocation with posterior wall of acetabulum, head of femur fracture, intertrochanteric fracture and even the most severe type of combined acetabular fracture. We report a 42-year-old man post traumatic bilateral hip injuries with irreducible posterior hip dislocation and associated isolated greater trochanteric fracture successfully managed with open reduction and fixation of greater trochanter with universal locking trochanteric stabilization plate.展开更多
Objective To investigate the feasibility and clinical effects of the pair ringer technology for bony avulsion of the posterior cruciate ligament under arthroscopy.Methods From January 2005 to July 2009,23 patientswere...Objective To investigate the feasibility and clinical effects of the pair ringer technology for bony avulsion of the posterior cruciate ligament under arthroscopy.Methods From January 2005 to July 2009,23 patientswere treated with the展开更多
A cruciate ligament avulsion is a much less common form of injury than a cruciate ligament tear.Simultaneous tibial avulsion fractures of both cruciate ligaments occur even more rarely.Over the last decades,many studi...A cruciate ligament avulsion is a much less common form of injury than a cruciate ligament tear.Simultaneous tibial avulsion fractures of both cruciate ligaments occur even more rarely.Over the last decades,many studies have described arthroscopic fixation of acute cruciate tibial avulsion fractures,but arthroscopic treatment in a late presenting patient has not been reported in the literature.This case report presents a 32-year-old female with a chronic tibial avulsion fracture of both anterior cruciate ligament and posterior cruciate ligament.Simultaneous fixation of both fractures was performed arthroscopically at week four post-injury.At one year of follow-up,the patient had demonstrated full knee range of motion and stable knee with no complaints,and achieved excellent clinical outcomes.Radiographs showed union of both fractures,and the patient had resumed high-impact exercises.展开更多
Brachial plexus avulsion(BPA)is a combined injury involving the central and peripheral nervous systems.Patients with BPA often experience severe neuropathic pain(NP)in the affected limb.NP is insensitive to the existi...Brachial plexus avulsion(BPA)is a combined injury involving the central and peripheral nervous systems.Patients with BPA often experience severe neuropathic pain(NP)in the affected limb.NP is insensitive to the existing treatments,which makes it a challenge to researchers and clinicians.Accumulated evidence shows that a BPA-induced pain state is often accompanied by sympathetic nervous dysfunction,which suggests that the excitation state of the sympathetic nervous system is correlated with the existence of NP.However,the mechanism of how somatosensory neural crosstalk with the sympathetic nerve at the peripheral level remains unclear.In this study,through using a novel BPA C7 root avulsion mouse model,we found that the expression of BDNF and its receptor TrκB in the DRGs of the BPA mice increased,and the markers of sympathetic nervous system activity includingα1 andα2 adrenergic receptors(α1-AR andα2-AR)also increased after BPA.The phenomenon of superexcitation of the sympathetic nervous system,including hypothermia and edema of the affected extremity,was also observed in BPA mice by using CatWalk gait analysis,an infrared thermometer,and an edema evaluation.Genetic knockdown of BDNF in DRGs not only reversed the mechanical allodynia but also alleviated the hypothermia and edema of the affected extremity in BPA mice.Further,intraperitoneal injection of adrenergic receptor inhibitors decreased neuronal excitability in patch clamp recording and reversed the mechanical allodynia of BPA mice.In another branch experiment,we also found the elevated expression of BDNF,TrκB,TH,α1-AR,andα2-AR in DRG tissues from BPA patients compared with normal human DRGs through western blot and immunohistochemistry.Our results revealed that peripheral BDNF is a key molecule in the regulation of somatosensory-sympathetic coupling in BPA-induced NP.This study also opens a novel analgesic target(BDNF)in the treatment of this pain with fewer complications,which has great potential for clinical transformation.展开更多
Purpose To assess the clinical efficacy of converting partial articular supraspinatus tendon avulsion(PASTA)lesions to full-thickness tears through a small local incision of the bursal-side supraspinatus tendon follow...Purpose To assess the clinical efficacy of converting partial articular supraspinatus tendon avulsion(PASTA)lesions to full-thickness tears through a small local incision of the bursal-side supraspinatus tendon followed by repair.Methods We retrospectively analyzed 41 patients with Ellman grade 3 PASTA lesions and an average age of(54.7±11.4)years from March 2013 to July 2017.Patients without regular conservative treatment and concomitant with other shoulder pathologies or previous shoulder surgery were excluded from the study.The tears were confirmed via arthroscopy,and a polydioxanone suture was placed to indicate the position of each tear.A small incision of approximately 6 mm was made using a plasma scalpel on the bursal-side supraspinatus tendon around the positioned suture to convert the partial tear into a full-thickness tear.The torn rotator cuff was sutured through the full thickness using a suture passer after inserting a 4.5-mm double-loaded suture anchor.Data were analyzed using a paired Student’s t-test with statistical significance defined as p<0.05.Results At the final follow-up of 2 years,the pain-free shoulder joint range of motion and visual analog scale score were significantly improved compared to those before surgery(p<0.001).The postoperative American Shoulder and Elbow Surgeons shoulder score was(90.6±6.2),which was significantly higher than the preoperative score of(47.9±8.3)(p<0.001).The University of California at Los Angeles shoulder rating scale score increased from(14.7±4.1)prior to surgery to(32.6±3.4)points after surgery(p<0.001).No patient had joint stiffness.Conclusion This modified tear completion repair,by conversion to full-thickness tears through a small incision,has less damage to the supraspinatus tendon on the side of the bursa compared to traditional tear completion repair in the treatment of PASTA lesions.This surgical method is a simple and effective treatment that can effectively alleviate pain and improve shoulder joint function.展开更多
BACKGROUND: Permanent tooth avulsion is one of the severe forms of dental traumatic injuries. The immediate action taken at the site of the accident is crucial to the prognosis of the tooth. Replantation is considered...BACKGROUND: Permanent tooth avulsion is one of the severe forms of dental traumatic injuries. The immediate action taken at the site of the accident is crucial to the prognosis of the tooth. Replantation is considered as the treatment of choice. OBJECTIVE: The study was undertaken to assess the knowledge of parents who accompany their children to the pediatric dental clinic, KATH on the pre-hospital management of avulsed permanent tooth in children. METHODS: A researcher administered structured questionnaire was used to collect data on the knowledge of pre-hospital management of avulsed permanent tooth from 83 parents who accompanied their wards to the pediatric dental clinic at KATH. RESULTS: A total of 83 parents were involved in the study. 30 (36%) were males while 53 (64%) were females. The majority of the parents (57%) were either university trained or had attended college of education. Only 32 parents (39%) were aware of the possibility of replantation. Majority of the parents chose non-physiologic media as the transport media of choice and only 10% would attempt self-replantation before seeking professional help. 76 parents (92%) had no previous education on pre-hospital management of avulsed tooth. CONCLUSION: The results obtained from this study indicate that parental knowledge on pre-hospital management of avulsed permanent tooth is low hence the need for massive public educational campaigns.展开更多
Triceps tendon avulsion(TTA)is an uncommon injury,and there are no classifications or treatment guidelines available.This study aims to describe a clinicoradiological classification and treatment algorithm for traumat...Triceps tendon avulsion(TTA)is an uncommon injury,and there are no classifications or treatment guidelines available.This study aims to describe a clinicoradiological classification and treatment algorithm for traumatic TTA in adults.The functional outcome of surgical repair has been evaluated too.;A retrospective analysis of adult patients with traumatic TTA treated in our institution between 2012 and 2017 was done.We only included complete TTA injuries.Children below 15 years,open injuries,associated fractures,and partial TTA were excluded.The data were obtained from hospital records.The intraoperative findings were correlated with the clinicoradiological presentation for classifying TTA.The functional outcome was analyzed using the Mayo Elbow Performance index and Hospital for Special Surgery elbow score.ANOVA test was used to assess the statistical significance.;There were 15 patients included,including 11 males and 4 females.The mean age was(31.5±9.15)years,and the mean follow-up was(22.4±8.4)months.Fall on outstretched hand was the mode of injury.In 6 patients,diagnosis was missed on the initial visit.TTA were classified as Type 1:palpable soft-tissue defect without bony mass;Type 2:palpable soft-tissue defect with a wafer-thin/comminuted bony fragment on X-ray;Type 3:palpable soft-tissue defect with a bony mass and a large bony fragment on X-ray without extension to the articular surface;and Type 4:an olecranon fracture with less than 25%of the articular surface.An algorithm for treatment was recommended,i.e.transosseous suture repair/suture anchor for Type 1,transosseous suture repair for Type 2,and tension band wiring or steel wire sutures for Types 3 and 4.All the patients achieved good to excellent outcome:the mean Mayo Elbow Performance index was 100 and Hospital for Special Surgery score was 98.26±2.60 on final follow-up.;Our clinicoradiological classification and treatment algorithm for TTAs is simple.Surgical treatment results in excellent functions of the elbow.Since it is a single-center study involving a very small number of cases,a multicenter study with a larger number of patients is required for external validation of our classification and treatment recommendations.展开更多
Background:Microsurgical replantation has become the most favorable treatment option for scalp avulsion.However,the accurate prediction of postoperative replant viability remains challenging.Case presentation:In this ...Background:Microsurgical replantation has become the most favorable treatment option for scalp avulsion.However,the accurate prediction of postoperative replant viability remains challenging.Case presentation:In this article,we showed that(indocyanine green angiography,ICGA)can provide a much more precise prediction of replant necrosis than conventional clinical assessment in a rare case of complete scalp avulsion with prolonged ischemia time.Conclusion:Clinical assessment of replant survival may be misleading in cases of complex tissue injuries and prolonged ischemic stress.This case provides insight into the promising utility of ICGA as an important adjuvant tool to better assess tissue perfusion and viability in scalp avulsion and possibly other types of replantation.展开更多
After brachial plexus avulsion(BPA),microglia induce inflammation,initiating and maintaining neuropathic pain.EZH2(enhancer of zeste homolog 2) has been implicated in inflammation and neuropathic pain,but the mechanis...After brachial plexus avulsion(BPA),microglia induce inflammation,initiating and maintaining neuropathic pain.EZH2(enhancer of zeste homolog 2) has been implicated in inflammation and neuropathic pain,but the mechanisms by which it regulates neuropathic pain remain unclear.Here,we found that EZH2 levels were markedly upregulated during BPA-induced neuropathic pain in vivo and in vitro,stimulating pro-inflammatory cytokines(IL-1β,TNF-α,and IL-6) secretion in vivo.In rats with BPAinduced neuropathic pain,mechanical and cold hypersensitivities were induced by EZH2 upregulation and inhibited by EZH2 downregulation in the anterior cingulate cortex.Microglial autophagy was also significantly inhibited,with EZH2 inhibition activating autophagy and reducing neuroinflammation in vivo.However,this effect was impaired by inhibiting autophagy with 3-methyladenine,suggesting that the MTOR signaling pathway is a functional target of EZH2.These data suggest that EZH2 regulates neuroinflammation and neuropathic pain via a novel MTOR-mediated autophagy signaling pathway,providing a promising approach for managing neuropathic pain.展开更多
文摘BACKGROUND Avulsion fracture of the ischial tuberosity is a relatively clinically rare type of trauma that is mainly incurred by adolescents during competitive sports activities.According to previous literature,the most commonly involved sports are soccer,sprinting,and gymnastics,in descending order.Dance-induced avulsion fracture of the ischial tuberosity and ischial ramus is extremely clinically rare.CASE SUMMARY A case of a neglected avulsion fracture of the ischial tuberosity and ischial ramus was diagnosed in a young female dancer who complained of pain and restricted movement of her right hip.She stated that she had suffered the injury while performing a split leap during a dance performance 9 mo prior.Eventually,she underwent surgery and obtained satisfactory treatment results.CONCLUSION Early diagnosis of these fractures is important to ensuring early proper treatment towards a quicker recovery.For old fractures with nonunion and chronic buttock pain,surgery is a preferred therapeutic choice with good treatment outcomes.
基金financially supported by the National Key Research and Development Program of China(Grant No.2023YFC3200026)the National Natural Science Foundation of China(Grant No.U2243238)。
文摘Channel avulsion is a natural phenomenon that occurs abruptly on alluvial river deltas,which can affect the channel stability.The causes for avulsion could be generally categorized as topography-and flood-driven factors.However,previous studies on avulsion thresholds usually focused on topography-driven factors due to the centurial or millennial avulsion timescales of the world’s most deltas,but neglected the impacts of flood-driven factors.In the current study,a novel demarcation equation including the two driven factors was proposed,with the decadal timescale of avulsion being considered in the Yellow River Estuary(YRE).In order to quantify the contributions of different factors in each category,an entropy-based methodology was used to calculate the contributing weights of these factors.The factor with the highest weight in each category was then used to construct the demarcation equation,based on avulsion datasets associated with the YRE.An avulsion threshold was deduced according to the demarcation equation.This avulsion threshold was then applied to conduct the risk assessment of avulsion in the YRE.The results show that:two dominant factors cover respectively geomorphic coefficient representing the topography-driven factor and fluvial erosion intensity representing the flood-driven factor,which were thus employed to define a two dimensional mathematical space in which the demarcation equation can be obtained;the avulsion threshold derived from the equation was also applied in the risk assessment of avulsion;and the avulsion threshold proposed in this study is more accurate,as compared with the existing thresholds.
文摘BACKGROUND Given its size and location,the liver is the third most injured organ by abdominal trauma.Thanks to recent advances,it is unanimously accepted that the nonoperative management is the current mainstay of treatment for hemodynamically stable patients.However,those patients with hemodynamic instability that generally present with severe liver trauma associated with major vascular lesions will require surgical management.Moreover,an associated injury of the main bile ducts makes surgery compulsory even in the case of hemodynamic stability,thereby imposing therapeutic challenges in the tertiary referral hepato-biliopancreatic centers’setting.CASE SUMMARY We present the case of a 38-year-old male patient with The American Association for the Surgery of Trauma grade V liver injury and an associated right branch of portal vein and common bile duct avulsion,due to a crush polytrauma.The patient was referred to the nearest emergency hospital and because of the hemorrhagic shock,damage control surgery was performed by means of ligation of the right portal vein branch and right hepatic artery,and hemostatic packing.Afterwards,the patient was referred immediately to our tertiary hepato-bilio-pancreatic center.We performed depacking,a right hepatectomy and Roux-en-Y hepaticojejunostomy.On the 9th postoperative day,the patient developed a high output anastomotic bile leak that required a redo of the cholangiojejunostomy.The postoperative period was marked by a surgical incision site of incomplete evisceration that was managed non-operatively by negative wound pressure.The follow-up was optimal,with no complications at 55 mo.CONCLUSION In conclusion,the current case clearly supports that a favorable outcome in severe liver trauma with associated vascular and biliary injuries is achieved thru proper therapeutic management,conducted in a tertiary referral hepato-bilio-pancreatic center,where a stepwise and complex surgical approach is mandatory.
文摘BACKGROUNDHip avulsion fractures occur mostly during adolescence when actions such askicking or running cause forceful contraction of attached muscle.Osteochondroma is benign tumor that mostly occurs at the metaphysis of a longbone, being usually asymptomatic.CASE SUMMARYA 15-year-old patient experienced feeling and sound of a break while kicking aball in soccer game three years prior to his visit to our hospital. A simple X-rayrevealed an avulsion fracture of the apophysis of the anterior inferior iliac spine(AIIS). Later in the follow-up X-ray, a palpable mass was found and demonstratedby magnetic resonance imaging to be a pedunculated osteochondroma in thesuperolateral aspect of the AIIS. For surgical treatment, we performed osteotomyfor surgical excision and excisional biopsy. A mass with smooth surface and anunclear superolateral AIIS border was found intraoperatively. Pathologic examshowed definite diagnosis of osteochondroma. Postoperatively, discomfort duringhip flexion was improved, and the hip joint range of motion during walking wasrecovered at the last follow-up, which was three weeks after the surgery.CONCLUSIONThis is a rare case to demonstrate relevant previous trauma history prior to theformation of osteochondroma.
基金financially supported by the National Natural Science Foundation of China,No.81371366(to HFW)the Natural Science Foundation of Guangdong Province of China,No.2015A030313515(to HFW)+1 种基金the Dongguan International Science and Technology Cooperation Project,No.2013508152010(to HFW)the Key Project of Social Development of Dongguan of China,No.20185071521640(to HFW)
文摘Brachial plexus avulsion often results in massive motor neuron death and severe functional deficits of target muscles. However, no satisfactory treatment is currently available. Hypoxia-inducible factor 1α is a critical molecule targeting several genes associated with ischemia-hypoxia damage and angiogenesis. In this study, a rat model of brachial plexus avulsion-reimplantation was established, in which C5–7 ventral nerve roots were avulsed and only the C6 root reimplanted. Different implants were immediately injected using a microsyringe into the avulsion-reimplantation site of the C6 root post-brachial plexus avulsion. Rats were randomly divided into five groups: phosphate-buffered saline, negative control of lentivirus, hypoxia-inducible factor 1α(hypoxia-inducible factor 1α overexpression lentivirus), gel(pluronic F-127 hydrogel), and gel + hypoxia-inducible factor 1α(pluronic F-127 hydrogel + hypoxia-inducible factor 1α overexpression lentivirus). The Terzis grooming test was performed to assess recovery of motor function. Scores were higher in the hypoxia-inducible factor 1α and gel +hypoxia-inducible factor 1α groups(in particular the gel + hypoxia-inducible factor 1α group) compared with the phosphate-buffered saline group. Electrophysiology, fluorogold retrograde tracing, and immunofluorescent staining were further performed to investigate neural pathway reconstruction and changes of neurons, motor endplates, and angiogenesis. Compared with the phosphate-buffered saline group, action potential latency of musculocutaneous nerves was markedly shortened in the hypoxia-inducible factor 1α and gel + hypoxia-inducible factor1α groups. Meanwhile, the number of fluorogold-positive cells and ChAT-positive neurons, neovascular area(labeled by CD31 around av ulsed sites in ipsilateral spinal cord segments), and the number of motor endplates in biceps brachii(identified by α-bungarotoxin) were all visibly increased, as well as the morphology of motor endplate in biceps brachil was clear in the hypoxia-inducible factor 1α and gel + hypoxia-inducible factor 1α groups. Taken together, delivery of hypoxia-inducible factor 1α overexpression lentiviral vectors mediated by pluronic F-127 effectively promotes spinal root regeneration and functional recovery post-brachial plexus avulsion. All animal procedures were approved by the Institutional Animal Care and Use Committee of Guangdong Medical University, China.
文摘BACKGROUND The tibial stop of anterior cruciate ligament(ACL) is fan-shaped and attached to the medial groove in front of the intercondylar spine,which is located between the anterior horn of the medial and lateral meniscus.The incidence of this fracture is low previously reported,which is common in children and adolescents.With the increase of sports injury and traffic injury and the deepening of understanding,it is found that the incidence of the disease is high at present.AIM To explore the difference between open reduction and internal fixation with small incision and high-intensity non-absorbable suture under arthroscopy in the treatment of tibial avulsion fracture of ACL.METHODS Seventy-six patients with tibial avulsion fracture of anterior cruciate ligament diagnosed and treated in Guanyun County People’s Hospital from April 2018 to June 2020 were retrospectively analyzed.According to the surgical methods,they were divided into group A(40 cases) and group B(36 cases).Patients in group A were treated with arthroscopic high-strength non-absorbable suture,and patients in group B were treated with small incision open reduction and internal fixation.The operation time,fracture healing time,knee joint activity and functional score before and after operation,and surgical complications of the two groups were compared.RESULTS The operation time of group A was higher than that of group B,and the difference was statistically significant(P < 0.05);the fracture healing time of group A was compared with that of group B,and the difference was not statistically significant(P > 0.05);The knee joint function activity was compared between two groups before operation,3 mo and 6 mo after operation,and the difference was not statistically significant(P > 0.05);the knee joint function activity of group A and group B at 3 mo and 6 mo after operation was significantly higher than that before operation(P < 0.05);the limp,support,lock,instability,swelling,upstairs,squatting,pain and Lysholm score were compared between the two groups before and 6 mo after operation,and the difference was not statistically significant(P > 0.05);the scores of limp,support,lock,instability,swelling,upstairs,squatting,pain and Lysholm in group A and group B at 6 mo after operation were significantly higher than those before operation(P > 0.05);the surgical complication rate of group A was 2.63%,which was lower than 18.42% of group B,and the difference was statistically significant(P > 0.05).CONCLUSION Both small incision open reduction and internal fixation and arthroscopic high-strength nonabsorbable sutures can achieve good results in the treatment of anterior cruciate ligament tibial avulsion fractures.The operation time of arthroscopic high-strength non-absorbable sutures is slightly longer,but the complication rate is lower.
文摘BACKGROUND Independent avulsion fractures with anterior cruciate ligament(ACL)or posterior cruciate ligament(PCL)attachment are relatively common among tibial intercondylar eminence fractures,and their postoperative outcomes are generally favorable.Conversely,huge avulsion fractures of the intercondylar eminence containing the attachment site of both the ACL and the PCL are extremely rare,and the reported clinical outcomes are poor.CASE SUMMARY We describe a 30-year-old Japanese male's huge avulsion fracture of the intercondylar eminence of a tibia containing the attachment site of both the ACL and PCL,together with a complete tear of the medial collateral ligament and a partial tear of both the medial and lateral menisci caused by a fall from a high place.All of these injuries were treated surgically,with anatomical reduction and stable fixation.The limb function at 1 year post-surgery was excellent(Lysholm score:100 points).CONCLUSION Although this patient's complete surgical repair was complex,it should be performed in similar cases for an excellent final clinical outcome.
文摘BACKGROUND Few cases of avulsion fractures of the tibial tuberosity with simultaneous rupture of the patellar tendon have been reported in the literature.Therefore,its mechanism and incidence have not been determined conclusively.This type of fracture is considered a serious injury that requires prompt diagnosis and early surgical repair.There is no therapeutic algorithm or standard method of treatment due to the infrequency of the injury.In this case report,we conducted an exhaustive review and synthesis of the existing literature including all previously reported cases.CASE SUMMARY We present a 16-year-old male soccer player with a case of a tibial tuberosity fracture with distal avulsion of the patellar tendon 5 d prior to surgical treatment.The patient presented with a loss of the extensor mechanism of the knee,edema,the inability to walk,and pain.X-rays showed a high patella and a 180-degree avulsion of the tibial tuberosity.The diagnosis was confirmed by magnetic resonance imaging and computed tomography.The patient underwent open reduction and internal fixation of the fracture with a cannulated screw and washer as well as patellar tendon repair with two metallic anchors.The rehabilitation protocol consisted of initial immobilization in extension followed by passive mobility and muscle strengthening exercises.The patient demonstrated excellent postoperative outcomes and returned to regular activity without complications.CONCLUSION This case presentation and literature review comprise the most relevant clinical,radiographic,and treatment details described in the international literature to date,providing the reader with an overview of this rare condition.
文摘BACKGROUND Ureteroscopy is well-established as a primary treatment modality for urolithiasis.Ureteral avulsion,particularly complete or full-length avulsion with a resultant long segment of the ureter left attached to the ureteroscope,is a rare but devastating complication of the procedure.Management of this complication is challenging.Moreover,general consensus regarding the optimal management is undetermined.We report our experience of managing a complete ureteral avulsion case via an extended Boari flap technique with long-term results.CASE SUMMARY A 41-year-old female patient subjected to complete ureteral avulsion caused by ureteroscopy was referred to our hospital.A modified,extended Boari flap technique was successfully performed to repair the full-length ureteral defect.Maximal mobilization of the bladder and affected kidney followed by psoas hitch and downward nephropexy maximized the probability of a tension-free anastomosis.Meticulous blood supply preservation to the flap also contributed to the success.During the 4-year study period,no complications except for a mild urinary frequency and a slightly lower maximum urinary flow rate were reported.The patient was satisfied with the surgical outcomes.CONCLUSION The extended Boari flap procedure is a feasible and preferred technique to manage complete ureteral avulsion,particularly in emergencies.
文摘The Huron River consists of alternating bedrock reaches and alluvial reaches. Analysis of historical aerial photography from 1950-2015 reveals six major channel avulsion events in the 8-km study area. These avulsions occurred in the alluvial reaches but were strongly influenced by the properties of the upstream bedrock reach (“inherited characteristics”). The bedrock reaches aligned with the azimuth of joint sets in the underlying bedrock. One inherited characteristic in the alluvial reach downstream is that the avulsion channels diverged only slightly from the orientation of the upstream bedrock channel (range 2 °- 38 °, mean and standard deviation 12.1 °± 13.7 °). A second inherited characteristic is that avulsion channels were initiated from short distances downstream after exiting the upstream bedrock channel reach (range 62 - 266 m, mean and standard deviation 143.7 ± 71.0 m), which is a fraction of the meander wavelength (1.2 km). Field evidence shows that some avulsion channel sites were re-occupied episodically. In addition, two properties were necessary for channel avulsions: 1) avulsion events were triggered by channel-forming hydrologic events (5-year recurrence interval flows), but not every channel-forming hydrologic event resulted in an avulsion, and 2) channel sinuosity (P) increased to 1.72 - 1.77 prior to an avulsion then decreased to 1.65 - 1.70 following an avulsion, suggesting that P ≥ 1.72 is the “critical sinuosity” or triggering value for avulsions on the Huron River. In summary, for this river consisting of alternating bedrock and alluvial reaches, the bedrock reaches impose certain parameters on downstream alluvial reaches (including sediment supply, channel direction and avulsion channel position downstream after exiting a bedrock reach) while adjustments in sinuosity and sediment storage occur in the alluvial reaches.
文摘Posterior hip dislocation with greater trochanter fracture is an uncommon injury pattern in the acute trauma patient. Frequently associated injury includes a combination of hip dislocation with posterior wall of acetabulum, head of femur fracture, intertrochanteric fracture and even the most severe type of combined acetabular fracture. We report a 42-year-old man post traumatic bilateral hip injuries with irreducible posterior hip dislocation and associated isolated greater trochanteric fracture successfully managed with open reduction and fixation of greater trochanter with universal locking trochanteric stabilization plate.
文摘Objective To investigate the feasibility and clinical effects of the pair ringer technology for bony avulsion of the posterior cruciate ligament under arthroscopy.Methods From January 2005 to July 2009,23 patientswere treated with the
文摘A cruciate ligament avulsion is a much less common form of injury than a cruciate ligament tear.Simultaneous tibial avulsion fractures of both cruciate ligaments occur even more rarely.Over the last decades,many studies have described arthroscopic fixation of acute cruciate tibial avulsion fractures,but arthroscopic treatment in a late presenting patient has not been reported in the literature.This case report presents a 32-year-old female with a chronic tibial avulsion fracture of both anterior cruciate ligament and posterior cruciate ligament.Simultaneous fixation of both fractures was performed arthroscopically at week four post-injury.At one year of follow-up,the patient had demonstrated full knee range of motion and stable knee with no complaints,and achieved excellent clinical outcomes.Radiographs showed union of both fractures,and the patient had resumed high-impact exercises.
基金supported by grants from the National Natural Science Foundation of China(82072526,82171212,and 81870867).
文摘Brachial plexus avulsion(BPA)is a combined injury involving the central and peripheral nervous systems.Patients with BPA often experience severe neuropathic pain(NP)in the affected limb.NP is insensitive to the existing treatments,which makes it a challenge to researchers and clinicians.Accumulated evidence shows that a BPA-induced pain state is often accompanied by sympathetic nervous dysfunction,which suggests that the excitation state of the sympathetic nervous system is correlated with the existence of NP.However,the mechanism of how somatosensory neural crosstalk with the sympathetic nerve at the peripheral level remains unclear.In this study,through using a novel BPA C7 root avulsion mouse model,we found that the expression of BDNF and its receptor TrκB in the DRGs of the BPA mice increased,and the markers of sympathetic nervous system activity includingα1 andα2 adrenergic receptors(α1-AR andα2-AR)also increased after BPA.The phenomenon of superexcitation of the sympathetic nervous system,including hypothermia and edema of the affected extremity,was also observed in BPA mice by using CatWalk gait analysis,an infrared thermometer,and an edema evaluation.Genetic knockdown of BDNF in DRGs not only reversed the mechanical allodynia but also alleviated the hypothermia and edema of the affected extremity in BPA mice.Further,intraperitoneal injection of adrenergic receptor inhibitors decreased neuronal excitability in patch clamp recording and reversed the mechanical allodynia of BPA mice.In another branch experiment,we also found the elevated expression of BDNF,TrκB,TH,α1-AR,andα2-AR in DRG tissues from BPA patients compared with normal human DRGs through western blot and immunohistochemistry.Our results revealed that peripheral BDNF is a key molecule in the regulation of somatosensory-sympathetic coupling in BPA-induced NP.This study also opens a novel analgesic target(BDNF)in the treatment of this pain with fewer complications,which has great potential for clinical transformation.
基金This paper is supported by Zhejiang Medical and Health Science and Technology Project(2019RC309)Taizhou Science and technology plan project(1701ky49).
文摘Purpose To assess the clinical efficacy of converting partial articular supraspinatus tendon avulsion(PASTA)lesions to full-thickness tears through a small local incision of the bursal-side supraspinatus tendon followed by repair.Methods We retrospectively analyzed 41 patients with Ellman grade 3 PASTA lesions and an average age of(54.7±11.4)years from March 2013 to July 2017.Patients without regular conservative treatment and concomitant with other shoulder pathologies or previous shoulder surgery were excluded from the study.The tears were confirmed via arthroscopy,and a polydioxanone suture was placed to indicate the position of each tear.A small incision of approximately 6 mm was made using a plasma scalpel on the bursal-side supraspinatus tendon around the positioned suture to convert the partial tear into a full-thickness tear.The torn rotator cuff was sutured through the full thickness using a suture passer after inserting a 4.5-mm double-loaded suture anchor.Data were analyzed using a paired Student’s t-test with statistical significance defined as p<0.05.Results At the final follow-up of 2 years,the pain-free shoulder joint range of motion and visual analog scale score were significantly improved compared to those before surgery(p<0.001).The postoperative American Shoulder and Elbow Surgeons shoulder score was(90.6±6.2),which was significantly higher than the preoperative score of(47.9±8.3)(p<0.001).The University of California at Los Angeles shoulder rating scale score increased from(14.7±4.1)prior to surgery to(32.6±3.4)points after surgery(p<0.001).No patient had joint stiffness.Conclusion This modified tear completion repair,by conversion to full-thickness tears through a small incision,has less damage to the supraspinatus tendon on the side of the bursa compared to traditional tear completion repair in the treatment of PASTA lesions.This surgical method is a simple and effective treatment that can effectively alleviate pain and improve shoulder joint function.
文摘BACKGROUND: Permanent tooth avulsion is one of the severe forms of dental traumatic injuries. The immediate action taken at the site of the accident is crucial to the prognosis of the tooth. Replantation is considered as the treatment of choice. OBJECTIVE: The study was undertaken to assess the knowledge of parents who accompany their children to the pediatric dental clinic, KATH on the pre-hospital management of avulsed permanent tooth in children. METHODS: A researcher administered structured questionnaire was used to collect data on the knowledge of pre-hospital management of avulsed permanent tooth from 83 parents who accompanied their wards to the pediatric dental clinic at KATH. RESULTS: A total of 83 parents were involved in the study. 30 (36%) were males while 53 (64%) were females. The majority of the parents (57%) were either university trained or had attended college of education. Only 32 parents (39%) were aware of the possibility of replantation. Majority of the parents chose non-physiologic media as the transport media of choice and only 10% would attempt self-replantation before seeking professional help. 76 parents (92%) had no previous education on pre-hospital management of avulsed tooth. CONCLUSION: The results obtained from this study indicate that parental knowledge on pre-hospital management of avulsed permanent tooth is low hence the need for massive public educational campaigns.
基金This study has been approved by the institutional research committee(GMCKKD/RP2017/IEC/106).
文摘Triceps tendon avulsion(TTA)is an uncommon injury,and there are no classifications or treatment guidelines available.This study aims to describe a clinicoradiological classification and treatment algorithm for traumatic TTA in adults.The functional outcome of surgical repair has been evaluated too.;A retrospective analysis of adult patients with traumatic TTA treated in our institution between 2012 and 2017 was done.We only included complete TTA injuries.Children below 15 years,open injuries,associated fractures,and partial TTA were excluded.The data were obtained from hospital records.The intraoperative findings were correlated with the clinicoradiological presentation for classifying TTA.The functional outcome was analyzed using the Mayo Elbow Performance index and Hospital for Special Surgery elbow score.ANOVA test was used to assess the statistical significance.;There were 15 patients included,including 11 males and 4 females.The mean age was(31.5±9.15)years,and the mean follow-up was(22.4±8.4)months.Fall on outstretched hand was the mode of injury.In 6 patients,diagnosis was missed on the initial visit.TTA were classified as Type 1:palpable soft-tissue defect without bony mass;Type 2:palpable soft-tissue defect with a wafer-thin/comminuted bony fragment on X-ray;Type 3:palpable soft-tissue defect with a bony mass and a large bony fragment on X-ray without extension to the articular surface;and Type 4:an olecranon fracture with less than 25%of the articular surface.An algorithm for treatment was recommended,i.e.transosseous suture repair/suture anchor for Type 1,transosseous suture repair for Type 2,and tension band wiring or steel wire sutures for Types 3 and 4.All the patients achieved good to excellent outcome:the mean Mayo Elbow Performance index was 100 and Hospital for Special Surgery score was 98.26±2.60 on final follow-up.;Our clinicoradiological classification and treatment algorithm for TTAs is simple.Surgical treatment results in excellent functions of the elbow.Since it is a single-center study involving a very small number of cases,a multicenter study with a larger number of patients is required for external validation of our classification and treatment recommendations.
基金supported by grants from the National Natural Science Foundation of China(81772086,8170120)the Shanghai Municipal Education Commission-Gaofeng Clinical Medicine Grant(20161424)+1 种基金Shanghai Sailing Program(16YF1403500,17YF1401900)China Postdoctoral Science Foundation(2018 M630449).
文摘Background:Microsurgical replantation has become the most favorable treatment option for scalp avulsion.However,the accurate prediction of postoperative replant viability remains challenging.Case presentation:In this article,we showed that(indocyanine green angiography,ICGA)can provide a much more precise prediction of replant necrosis than conventional clinical assessment in a rare case of complete scalp avulsion with prolonged ischemia time.Conclusion:Clinical assessment of replant survival may be misleading in cases of complex tissue injuries and prolonged ischemic stress.This case provides insight into the promising utility of ICGA as an important adjuvant tool to better assess tissue perfusion and viability in scalp avulsion and possibly other types of replantation.
基金supported by the National Natural Science Foundation of China (81572127)。
文摘After brachial plexus avulsion(BPA),microglia induce inflammation,initiating and maintaining neuropathic pain.EZH2(enhancer of zeste homolog 2) has been implicated in inflammation and neuropathic pain,but the mechanisms by which it regulates neuropathic pain remain unclear.Here,we found that EZH2 levels were markedly upregulated during BPA-induced neuropathic pain in vivo and in vitro,stimulating pro-inflammatory cytokines(IL-1β,TNF-α,and IL-6) secretion in vivo.In rats with BPAinduced neuropathic pain,mechanical and cold hypersensitivities were induced by EZH2 upregulation and inhibited by EZH2 downregulation in the anterior cingulate cortex.Microglial autophagy was also significantly inhibited,with EZH2 inhibition activating autophagy and reducing neuroinflammation in vivo.However,this effect was impaired by inhibiting autophagy with 3-methyladenine,suggesting that the MTOR signaling pathway is a functional target of EZH2.These data suggest that EZH2 regulates neuroinflammation and neuropathic pain via a novel MTOR-mediated autophagy signaling pathway,providing a promising approach for managing neuropathic pain.
