RESUMEN
OBJECTIVE: The management of length-unstable femoral shaft fractures(LUFSFs) in pediatric patients is still controversial. This study aims to explore the clinical efficacy of ultrasound-guided closed reduction combined with external fixation for treating LUFSFs in children. METHODS: We conducted a retrospective analysis of clinical data from 19 pediatric patients with LUFSFs who underwent ultrasound-guided closed reduction and external fixation between January 2018 and January 2023. Ultrasound was employed not only to facilitate closed reduction of the fracture but also to guide real-time insertion of Schanz pins and monitor pin length as it traversed the opposite cortex. Surgical time, intraoperative fluoroscopy count, hospital stay length, fracture fixation duration, complication incidence, fracture reduction quality at the final follow-up were recorded. RESULTS: The patients' average age was 7.5 years( range: 5 to 11 years). The mean surgical duration was 70.4 min (range: 48-105 min), and the average intraoperative fluoroscopy count was 6.5 (range: 2-16). Fracture fixation lasted an average of 10.9 weeks (range: 7-20 weeks). All patients were followed up for more than one year. 6 cases of superficial pin tract infection occurred, which resolved with oral antibiotics and enhanced needle tract care. No deep infections were observed. Temporary stiffness of the knee joint was observed in 2 patients. According to Flynn's efficacy evaluation system, fracture reduction quality at the final follow-up was rated as excellent in 11 cases and satisfactory in 8 cases, yielding a combined success rate of 100% (19/19). CONCLUSIONS: The technique of ultrasound-guided closed reduction combined with external fixation offers favorable outcomes for children aged 5 to 11 years with LUFSFs, reducing reliance on fluoroscopic guidance.
Asunto(s)
Fracturas del Fémur , Fijación de Fractura , Ultrasonografía Intervencional , Humanos , Niño , Estudios Retrospectivos , Femenino , Preescolar , Fracturas del Fémur/cirugía , Fracturas del Fémur/diagnóstico por imagen , Masculino , Ultrasonografía Intervencional/métodos , Fijación de Fractura/métodos , Reducción Cerrada/métodos , Resultado del Tratamiento , Clavos Ortopédicos , Tempo OperativoRESUMEN
Volatile organic compounds (VOCs) are ubiquitous in both indoor and outdoor environments. Evidence on the associations of individual and joint VOC exposure with all-cause and cause-specific mortality is limited. Measurements of 15 urinary VOC metabolites were available to estimate exposure to 12 VOCs in the National Health and Nutritional Examination Survey (NHANES) 2005-2006 and 2011-2018. The environment risk score (ERS) was calculated using LASSO regression to reflect joint exposure to VOCs. Follow-up data on death were obtained from the NHANES Public-Use Linked Mortality File through December 31, 2019. Cox proportional hazard models and restricted cubic spline models were applied to evaluate the associations of individual and joint VOC exposures with all-cause and cause-specific mortality. Population attributable fractions were calculated to assess the death burden attributable to VOC exposure. During a median follow-up of 6.17 years, 734 (8.34 %) deaths occurred among 8799 adults. Urinary metabolites of acrolein, acrylonitrile, 1,3-butadiene, and ethylbenzene/styrene were significantly associated with all-cause, cardiovascular disease (CVD), respiratory disease (RD), and cancer mortality in a linear dose-response manner. Linear and robust dose-response relationships were also observed between ERS and all-cause and cause-specific mortality. Each 1-unit increase in ERS was associated with a 33.6 %, 39.1 %, 109.8 %, and 67.8 % increase for all-cause, CVD, RD, and cancer mortality risk, respectively. Moreover, joint exposure to VOCs contributed to 17.95 % of all-cause deaths, 13.49 % of CVD deaths, 35.65 % of RD deaths, and 33.85 % of cancer deaths. Individual and joint exposure to VOCs may enhance the risk of all-cause and cause-specific mortality. Reducing exposure to VOCs may alleviate the all-cause and cause-specific death burden.
Asunto(s)
Contaminantes Atmosféricos , Derivados del Benceno , Exposición a Riesgos Ambientales , Compuestos Orgánicos Volátiles , Humanos , Estudios Prospectivos , Masculino , Estados Unidos/epidemiología , Adulto , Exposición a Riesgos Ambientales/estadística & datos numéricos , Femenino , Persona de Mediana Edad , Contaminantes Atmosféricos/análisis , Encuestas Nutricionales , Enfermedades Cardiovasculares/mortalidad , Butadienos , Neoplasias/mortalidad , Enfermedades Respiratorias/mortalidad , MortalidadRESUMEN
Treatment of radial neck fractures (RNFs) in children, particularly those with severe displacement or angulation, remains controversial, largely due to the challenge of achieving optimal reduction without resorting to open reduction. This study aimed to assess the outcomes of ultrasonography (US)-guided percutaneous leverage reduction coupled with US-guided fixation using either elastic stable intramedullary nail (ESIN) or Kirschner wire (KW) for severely displaced Judet type III and IV RNFs in children. We hypothesized that both strategies would be effective and aimed to identify the superior approach. A total of 38 pediatric patients presenting with Judet type III and IV RNFs resulting from falls were treated surgically between January 2020 and January 2022. The cohort comprised 15 boys and 23 girls, aged on average 7.6 ± 2.3 (range: 2.8-11.3 years). The fractures were classified as type III (n = 28) and type IV (n = 10). The patients were divided into 2 treatment groups: ESIN group (n = 15; treated with US-guided percutaneous leverage reduction and ESIN fixation) and the KW group (n = 23; treated with US-guided percutaneous leverage reduction and KW fixation). Variables such as surgical time, frequency of intraoperative radiography, fracture healing time, hospitalization costs, radiographic outcomes, and functional elbow scores were analyzed. Most fractures demonstrated both clinical and radiographic evidence of complete healing within 7 weeks. Based on the Tibone and Stoltz classification (Tibone J, Stoltz M. Fractures of the radial head and neck in children. J Bone Joint Surg Am. 1981;63:100-6), almost all patients had excellent or good clinical outcomes, with only one exception in the ESIN group. The KW group exhibited significantly lower hospitalization costs compared to the ESIN group [(9562.6 vs 12,043.6 + 7694.0)¥, P < .05]. Both groups required notably few intraoperative radiographic exposures (KW: 5.4 ± 2.1 times, ESIN: 4.0 ± 1.9 times, P < .05). No major complications were reported. However, one case of ESIN displacement and joint protrusion was noted. Our study suggests that US-guided percutaneous leverage reduction, combined with either ESIN or KW fixation, is an effective treatment for severely displaced radial neck fractures in children. Both treatment modalities resulted in notably few intraoperative radiographic exposures and yielded favorable clinical and radiological outcomes. The integration of US-guided leverage reduction and KW fixation is both cost-effective and safe.
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Fijación Intramedular de Fracturas , Fracturas Radiales de Cabeza y Cuello , Fracturas del Radio , Masculino , Femenino , Humanos , Niño , Anciano , Hilos Ortopédicos , Fijación Intramedular de Fracturas/métodos , Clavos Ortopédicos , Resultado del Tratamiento , Fracturas del Radio/diagnóstico por imagen , Fracturas del Radio/cirugía , Fracturas del Radio/etiología , Ultrasonografía , Curación de Fractura , Estudios Retrospectivos , Ultrasonografía IntervencionalRESUMEN
The two major intracellular protein degradation systems, the ubiquitin-proteasome system (UPS) and autophagy, work collaboratively in many biological processes including development, apoptosis, aging, and countering oxidative injuries. We report here that, in human retinal pigment epithelial cells (RPE), ARPE-19 cells, proteasome inhibitors, clasto-lactacystinß-lactone (LA) or epoxomicin (Epo), at non-lethal doses, increased the protein levels of autophagy-specific genes Atg5 and Atg7 and enhanced the conversion of microtubule-associated protein light chain (LC3) from LC3-I to its lipidative form, LC3-II, which was enhanced by co-addition of the saturated concentration of Bafilomycin A1 (Baf). Detection of co-localization for LC3 staining and labeled-lysosome further confirmed autophagic flux induced by LA or Epo. LA or Epo reduced the phosphorylation of the protein kinase B (Akt), a downstream target of phosphatidylinositol-3-kinases (PI3K), and mammalian target of rapamycin (mTOR) in ARPE-19 cells; by contrast, the induced changes of autophagy substrate, p62, showed biphasic pattern. The autophagy inhibitor, Baf, attenuated the reduction in oxidative injury conferred by treatment with low doses of LA and Epo in ARPE-19 cells exposed to menadione (VK3) or 4-hydroxynonenal (4-HNE). Knockdown of Atg7 with siRNA in ARPE-19 cells reduced the protective effects of LA or Epo against VK3. Overall, our results suggest that treatment with low levels of proteasome inhibitors confers resistance to oxidative injury by a pathway involving inhibition of the PI3K-Akt-mTOR pathway and activation of autophagy.
Asunto(s)
Autofagia , Estrés Oxidativo , Fosfatidilinositol 3-Quinasas/metabolismo , Inhibidores de Proteasoma/farmacología , Proteínas Proto-Oncogénicas c-akt/metabolismo , Epitelio Pigmentado de la Retina/metabolismo , Serina-Treonina Quinasas TOR/metabolismo , Proteína 5 Relacionada con la Autofagia , Proteína 7 Relacionada con la Autofagia , Línea Celular , Humanos , Proteínas Asociadas a Microtúbulos/genética , Proteínas Asociadas a Microtúbulos/metabolismo , Epitelio Pigmentado de la Retina/efectos de los fármacos , Transducción de Señal , Enzimas Activadoras de Ubiquitina/genética , Enzimas Activadoras de Ubiquitina/metabolismoRESUMEN
PREMISE OF THE STUDY: A set of novel chloroplast microsatellite markers (cpSSRs) was developed for the bioenergy crop Miscanthus, and their utility in cross-species amplification was evaluated. METHODS AND RESULTS: Twenty-eight novel primers flanking cpSSR loci were designed from a complete chloroplast genome sequence of Saccharum officinarum, a species closely related to Miscanthus. These primers were then tested on eight Miscanthus species, among which 16 cpSSR loci were found to be polymorphic. The number of alleles per polymorphic locus ranged from two to seven, with an average 3.94 alleles. CONCLUSIONS: These cpSSR markers can be applied to all Miscanthus species and will be useful for studying Miscanthus population structure, diversity, and phylogeography.