Isolated Post-Traumatic Radial Head Dislocation, A Rare and Easily Missed Injury-A Case Report

Dislocation of the head of the radius may be either congenital, an isolated injury or more commonly part of a complex injury to the elbow such as the Monteggia fracturedislocation. Isolated traumatic radial head dislocation without associated injuries in children is a rare and easily missed condition. We report such a case in a 7-year-old boy without any associated injuries or co-morbid conditions. Initially the diagnosis was missed, and 6 weeks later open reduction was performed with annular ligament reconstruction surgery. At the one-year follow up, the patient had returned to most normal activities, showing only slight terminal restriction of pronation. We discuss the injury mechanism and management for the Monteggia fracturedislocation and review the available literature

Guidelines for the use and interpretation of assays for monitoring autophagy (4th edition)1.

In 2008, we published the first set of guidelines for standardizing research in autophagy. Since then, this topic has received increasing attention, and many scientists have entered the field. Our knowledge base and relevant new technologies have also been expanding. Thus, it is important to formulate on a regular basis updated guidelines for monitoring autophagy in different organisms. Despite numerous reviews, there continues to be confusion regarding acceptable methods to evaluate autophagy, especially in multicellular eukaryotes. Here, we present a set of guidelines for investigators to select and interpret methods to examine autophagy and related processes, and for reviewers to provide realistic and reasonable critiques of reports that are focused on these processes. These guidelines are not meant to be a dogmatic set of rules, because the appropriateness of any assay largely depends on the question being asked and the system being used. Moreover, no individual assay is perfect for every situation, calling for the use of multiple techniques to properly monitor autophagy in each experimental setting. Finally, several core components of the autophagy machinery have been implicated in distinct autophagic processes (canonical and noncanonical autophagy), implying that genetic approaches to block autophagy should rely on targeting two or more autophagy-related genes that ideally participate in distinct steps of the pathway. Along similar lines, because multiple proteins involved in autophagy also regulate other cellular pathways including apoptosis, not all of them can be used as a specific marker for bona fide autophagic responses. Here, we critically discuss current methods of assessing autophagy and the information they can, or cannot, provide. Our ultimate goal is to encourage intellectual and technical innovation in the field

Global, regional, and national incidence of six major immune-mediated inflammatory diseases: findings from the global burden of disease study 2019

Background The causes for immune-mediated inflammatory diseases (IMIDs) are diverse and the incidence trends of IMIDs from specific causes are rarely studied. The study aims to investigate the pattern and trend of IMIDs from 1990 to 2019. Methods We collected detailed information on six major causes of IMIDs, including asthma, inflammatory bowel disease, multiple sclerosis, rheumatoid arthritis, psoriasis, and atopic dermatitis, between 1990 and 2019, derived from the Global Burden of Disease study in 2019. The average annual percent change (AAPC) in number of incidents and age standardized incidence rate (ASR) on IMIDs, by sex, age, region, and causes, were calculated to quantify the temporal trends. Findings In 2019, rheumatoid arthritis, atopic dermatitis, asthma, multiple sclerosis, psoriasis, inflammatory bowel disease accounted 1.59%, 36.17%, 54.71%, 0.09%, 6.84%, 0.60% of overall new IMIDs cases, respectively. The ASR of IMIDs showed substantial regional and global variation with the highest in High SDI region, High-income North America, and United States of America. Throughout human lifespan, the age distribution of incident cases from six IMIDs was quite different. Globally, incident cases of IMIDs increased with an AAPC of 0.68 and the ASR decreased with an AAPC of −0.34 from 1990 to 2019. The incident cases increased across six IMIDs, the ASR of rheumatoid arthritis increased (0.21, 95% CI 0.18, 0.25), while the ASR of asthma (AAPC = −0.41), inflammatory bowel disease (AAPC = −0.72), multiple sclerosis (AAPC = −0.26), psoriasis (AAPC = −0.77), and atopic dermatitis (AAPC = −0.15) decreased. The ASR of overall and six individual IMID increased with SDI at regional and global level. Countries with higher ASR in 1990 experienced a more rapid decrease in ASR. Interpretation The incidence patterns of IMIDs varied considerably across the world. Innovative prevention and integrative management strategy are urgently needed to mitigate the increasing ASR of rheumatoid arthritis and upsurging new cases of other five IMIDs, respectively. Funding The Global Burden of Disease Study is funded by the Bill and Melinda Gates Foundation. The project funded by Scientific Research Fund of Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital (2022QN38)

Thompson's quadricepsplasty for stiff knee

BACKGROUND: Stiffness of the knee after trauma and/or surgery for femoral fractures is one of the most common complications and is difficult to treat. Stiffness in extension is more common and can be reduced by vigorous physiotherapy. If it does not improve then quadricepsplasty is indicated. The present study was undertaken to evaluate the results of Thompsons quadricepsplasty. MATERIALS AND METHODS: Twenty-two male patients (age range 20-45 years) with posttraumatic knee stiffness following distal femoral fractures underwent Thompson's quadricepsplasty where knee flexion range was less than 45°. The index injury in these patients was treated with plaster cast (n=5), plates (n=3), intramedullary nailing (n=3) and external fixator for open fractures (n=9). Thompson's quadricepsplasty was performed in all the patients using anterior approach, with incision extending from the upper thigh to the tibial tubercle. Release of rectus femoris from underlying vastus intermedius and release of intraarticular adhesions were performed. After surgery the patients needed parenteral analgesia for three days and then oral analgesics for three weeks. Active assisted knee mobilization exercises was started on the first postoperative day. Continuous passive motion machine was used from the same day. Supervised physiotherapy was continued in hospital for six weeks followed by intensive knee flexion and extension exercise including cycling at home for atleast another six months. RESULTS: Out of 22 patients, 20 had excellent to good results and two patients had poor results using criteria devised by Judet. One poor result was due to peroperative fracture of patella which was then internally fixed and hence the flexion of knee could not be started immediately. There was peroperative avulsion of tibial tuberosity in another patient who finally gained less than 50° knee flexion and hence a poor result. CONCLUSION: Thompsons quadricepsplasty followed by a strict and rigourous postoperative physiotherapy protocol successfully increases the range of knee flexion