Objective The aim of this study is to assess the clinical results of bifocal or trifocal bone transport using unilateral rail system in the treatment of large tibial defects caused by infection. Methods There were a total of 37 eligible patients with an average age of 40.11 ± 10.32 years (range, 18–57 years; 28 males and nine females) with large tibial defects due to infection who were admitted to our hospital from June 2006 to June 2016. Among the patients, 21 underwent bifocal bone transport (BF group), and the remaining 16 were treated with trifocal bone transport (TF group). The demographic data (age, sex, interval duration before bone transport, previous operation time), intraoperative outcomes (size and location of the defect, size of soft tissue defect), postoperative variables (lengthening speed, external fixation index, duration of regenerate consolidation and docking union), postoperative bone and functional outcomes evaluated by Association for the Study and Application of the Method of Ilizarov (ASAMI) scoring system, and postoperative complications evaluated by Paley classification (muscle contraction, axial deviation, delayed consolidation, pin problems, repeated fracture, joint stiffness and others) of the two groups were recorded and compared at a minimum follow‐up of 24 months. Results The mean duration of follow‐up after removal of fixator was 29.49 ± 4.34 months (range, 24–38 months). There was no statistically significant difference in the demographic data, intraoperative outcomes including size and location of the defect, size of soft tissue defect, as well as postoperative complications. However, postoperative functional result in the TF group were superior to those in the BF group at a minimum follow‐up of 24 months, and lengthening speed, external fixation index (EFI), duration of regenerate consolidation and docking union were significantly reduced in the TF group when compared with the BF group. Conclusions Treatment of large tibial defects caused by infection with trifocal bone transport using unilateral rail system could significantly improve postoperative functional recovery and reduce duration of regenerate consolidation and docking union. The present study provides novel insight for the treatment of large tibial defects caused by infection.

BackgroundThe purpose of this study is to evaluate the clinical effectiveness and determine the differences, if any, between the trifocal bone transport (TFT) technique and the bifocal bone transport (BFT) technique in the reconstruction of long segmental tibial bone defects caused by infection using a monolateral rail external fixator.MethodsA total of 53 consecutive patients with long segmental tibial bone defects caused by infection and treated by monolateral rail external fixator in our department were retrospectively collected and analyzed from the period January 2013 to April 2019, including 39 males and 14 females with an average age of 38.8 ± 12.4 years (range 19–65 years). Out of these, 32 patients were treated by the BFT technique, and the remaining 21 patients were managed by the TFT technique. The demographic data, operation duration (OD), docking time (DT), external fixation time (EFT), and external fixation index (EFI) were documented and analyzed. Difficulties that occur during the treatment were classified according to Paley. The clinical outcomes were evaluated by following the Association for the Study and Application of the Method of Ilizarov (ASAMI) criteria at the last clinical visit.ResultsAll patients achieved an infection-free union finally, and there was no significant difference between the two groups in terms of demographic data and both ASAMI bone and functional scores (p > 0.05). The mean defect size and OD in TFT (9.4 ± 1.5 cm, 161.9 ± 8.9 min) were larger than that in BFT (7.8 ± 1.8 cm, 122.5 ± 11.2 min) (p < 0.05). The mean DT, EFT, and EFI in TFT (65.9 ± 10.8 days, 328.0 ± 57.2 days, 34.8 ± 2.1 days/cm) were all less than those in BFT (96.8 ± 22.6 days, 474.5 ± 103.2 days, 60.8 ± 1.9 days/cm) (p < 0.05). Difficulties and complications were more prevalent in the BFT group than in the TFT group (p < 0.05).ConclusionBoth the trifocal and BFT techniques achieve satisfactory clinical outcomes in the reconstruction of long segmental tibial bone defects caused by infection using a monolateral rail external fixator. The TFT technique can significantly decrease the DT, EFT, EFI, difficulties, and complications compared with the BFT technique.

Objective The aim of this study is to evaluate the clinical outcome of flap transfer followed by delayed bone transport using external fixator on the soft tissue defect with segmental tibial loss. Methods A total of 14 patients with soft tissue defects and bone loss were treated with flap transfer combined followed by delayed bone transport using external fixator from January 2010 to January 2017 and, successfully, follow-up were included. Demographic data and data on clinical outcomes and complications were obtained from hospital record. The mean age was 35.5 years, and the average time from injury to reconstructive surgery was 4.14 months. The average soft tissue and bone defect sizes were 33.57 cm2 and 7.04 cm, respectively. Local or free flap was created to reconstruct the soft tissue defects. The Ilizarov external fixator or Orthofix limb reconstruction system (OLRS) was used to reconstruct bony defects by bifocal or trifocal bone transport using delayed distraction osteogenesis. The functional results were evaluated by Association for the Study and Application of the Method of Ilizarov scoring system, and all postoperative complications were recorded. Results The mean duration of follow-up after removal of fixator was 29.49 ± 4.34 months (range, 24–38 months). All wounds healed after 1-stage operation, and all transferred flaps were survived. The average interval between flap coverage and bone transportation was 13.4 weeks (range, 8–24 weeks). Eight patients used bifocal, and 6 patients used trifocal approach for bone transportation. An average external fixation time was 208.5 days (range, 168–235 days) and external fixation index was 33.6 days/cm (range, 18.8–46.5 days/cm). Superficial necrosis of the flap edge was noted in 4 cases, after debridement and regular dressing, the flap healed successfully. Bone union was achieved in all patients except 4 cases that occurred with docking site nonunion which achieved satisfactory union after application of accordion maneuver and autografting of iliac bone. All patients achieved satisfactory functional recovery and were able to walk normally. Conclusions The flap transfer followed by delayed distraction osteogenesis using external fixator which can be used for successful reconstruction of bone and soft tissue defects in lower leg.

Background: Patients undergoing revision surgical treatment of the ulnar nerve at the elbow for cubital tunnel syndrome (CuTS) will have worse results compared to patients successfully treated with primary surgery. Objective: The purpose of this study is to evaluated clinical outcomes of revision neurolysis and ulnar groove plasty for recurrent and persistent cubital tunnel syndrome after failed surgical treatment. Methods: This retrospective investigation included patients presented with recurrent and persistent CuTS who were treated surgically with combination of revision neurolysis and ulnar groove plasty at a single institution from May 2006 to Oct 2016 with postoperative follow-up more than 24 months. Demographic data of all patients including age, sex, months to revision surgery, presenting symptoms after index surgery, previous surgical procedure and intraoperative findings were all recorded and pre-operative and post-operative data were compared. McGowen grading was used to evaluated functional impairment before and after revision surgery. Results: There were 28 patients were identified with recurrent and persistent CuTS after primary surgery and 21 patients (75%) were completed in this study with an average age was 56 years, mean duration of symptoms was 17.24 months, and mean postoperative follow-up was 35.38 months. 17 patients had McGowan stage III and 4 had stage II preoperatively. The most common cause of recurrent and persistent CuTS was perineural fibrosis with or without kink which accounts for 86.36% according to intraoperative findings. McGowan grading improved after revision neurolysis and ulnar groove plasty is 80.95%. Improvement of Visual Analogue Scale (VAS) and 2-point discrimination test were 81.25% and 85.71%, respectively. Patients satisfaction after revision neurolysis and ulnar groove plasty was 95.24%. Conclusion:The favorable results of this study demonstrated that revision neurolysis and ulnar groove plasty as the treatment of choice for recurrent or persistent cubital tunnel syndrome.

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Introduction: Right bundle branch block (RBBB) pattern is sometimes observed in right ventricular (RV) endocardial pacing. However, the true mechanism and the clinical meaning of this phenomenon are still unknown.Methods and results: Out of 218 consecutive patients with RV apex endocardial pacing, we studied 30 cases with RBBB pattern and 111 cases with left bundle branch block (LBBB) pattern. No significant differences were found between these 2 groups in age, sex, and pacing mode. However, the percentage of cardiomyopathy patients in the RBBB pattern group was significantly higher than in the LBBB pattern group (36.7% versus 1.8%, p < 0:0001). The left ventricular diastolic dimension (52:2 AE 9:3 mm versus 48:0 AE 5:5 mm, p ¼ 0:05) was bigger and left ventricular ejection fraction (56:2 AE 14:7% versus 66:4 AE 11:6%, p ¼ 0:0003) was lower in the RBBB pattern group. In RBBB pattern group, 11 out of 13 patients with low cardiac function (ejection fraction <50%) showed a wide QRS duration greater than 160 ms in V1 and II leads.Conclusions: RBBB pattern, especially QRS duration wider than 160 ms in V1 and II leads, during RV endocardial pacing may represent left ventricular enlargement and dysfunction. These findings would help assess the cardiac function based on surface 12-lead electrocardiography even in RV pacing. (J Arrhythmia 2009; 25: 16-23)

BACKGROUND The correct time for harvesting is a key factor contributing to the production of high‐quality maize seeds. We conducted field experiments to harvest seeds at 11 developmental stages for 3 years, to investigate seed vigor traits in three early maturity maize varieties and two late maturity varieties in one location. RESULTS Significant correlations (r = 0.72 ~ 0.89) were found among six seed‐related traits: standard germination (SG), accelerated aging germination (AAG), cold test germination (CTG), hundred‐seed weight (HSW), seed moisture content (SMC), and ≥ 10 °C accumulated temperature from pollination to harvest (AT10). Analysis of variance showed that harvest stage, year, and variety had significant effects on all traits, and harvest stage displayed the greatest effect. The responses of SG, AAG, CTG, HSW and SMC to harvest stage fitted quadratic models, and AT10 fitted a linear model. From the quadratic models, an ideal harvest time (IHT, the final date to reach maximum SG, AAG, and CTG) could be calculated for each variety. The three early maturity varieties reached their IHT at 54.94–58.44 days after pollination (DAP); the two later maturity varieties reached IHT several days later (at 59.87–59.90 DAP). The early maturity varieties consistently required less AT10 to reach the IHT than the later maturity varieties. However, all of the varieties reached the IHT at similar SMC levels of about 35%. CONCLUSION The later maturity varieties reached the IHT at later DAPs when they acquired more AT10 than the early maturity varieties but both reached it at similar SMC levels. © 2022 Society of Chemical Industry.

Background: The purpose of this study was to evaluate the efficacy of bone transport using unilateral external fixator in the treatment of lower limb bone defects caused by infection, and investigate the risk factors of transport gap bending deformity (TGBD) after removal of external fixator.Methods: From January 2008 to December 2019, 178 patients with bone defects of the lower extremity caused by infection were treated by bone transport using unilateral external fixator in our medical institution. The Association for the Study and Application of the Method of Ilizarov (ASAMI) standard was applied to assess the bone and functional outcomes. After the data were significant by the T-test or Pearson’s Chi-square test analyzed, odds ratios were calculated using logistic regression tests to describe factors associated with the diagnosis of TGBD.Results: A total of 178 patients met the inclusion criteria were successfully treated by bone transport using unilateral external fixator, with a mean size of 6.2 centimeters (3.4 - 9.1 cm). TGBD was observed in 22 patients (12.3%) after removal of the external fixator, including 32 tibias and 10 femurs, with a mean follow-up time of 28.6 months (22 - 47 months). Age>45years, BMI>25kg/m2, defect of the tibia, diabetes, osteoporosis, glucocorticoid intake, duration of bone infection>24months, EFT>9months, EFI>1.8months/cm were significantly associated with the occurrence of TGBD in the binary logistic regression analysis. The independent risk factors associated with TGBD included age>45 years, BMI>25 kg/m2, defect of tibia, diabetes, and osteoporosis. Conclusions: The bone transport using the unilateral external fixator was a safe and practical method in the treatment of lower limb bone defects caused by infection. The top five risk factors of TGBD included defect of tibia, BMI>25kg/m2, duration of bone infection>24 months, age>45years, and diabetes. Age>45years, BMI>25kg/m2, defect of tibia, osteoporosis, and diabetes were the independent risk factors. The higher incidence of TGBD may be associated with more risk factors.