Circulating microRNA (miRNA) expression profiles have been reported to be promising biomarkers for drug-induced liver injury in preclinical and clinical practice. Proper normalization is critical for accurate miRNAs expression analysis. Herein, using SYBR green quantitative real-time PCR (RT-qPCR), we evaluated the expression stability of six candidate reference genes including two commonly used small RNAs (U6, 5S) and four miRNAs (let-7a, miR-92a, miR-103 and miR-16) in plasma of rats with acetaminophen-induced hepatotoxicity. Data were analysed using geNorm, Normfinder, BestKeeper and comparative delta-Ct statistical models, and the results consistently show that miR-103 is the most stably expressed reference gene. Whereas the commonly used housekeeping genes 5S or U6 are all not suitable normalizers, because 5S exhibits extensive variability in expression and U6 has a low expression level across the plasma samples. Then the effect of reference genes on normalization of plasma miR-122 was assessed; when normalized to the most stable reference gene there were significant differences between the acetaminophen-treated group and the vehicle group. However, when the data were normalized to a less stably expressed gene, miR-16, a biased result was obtained. Therefore, we recommend that miR-103 as suitable reference gene for plasma miRNAs analysis for acetaminophen-induced liver injury. Data presented in this paper are crucial to successful biomarker discovery and validation for the diagnosis of the early stage of acetaminophen hepatotoxicity.

Rationale:Monomelic amyotrophy (MMA) is a benign motor neuron disease with bilateral muscular atrophy in asymmetry and abnormal in the electromyography (EMG). However, we report a case by the muscle biopsy which shows symptoms of slowly progressive amyotrophy despite having a normal EMG.Patient concerns:A 51-year-old male was diagnosed with a lower limb amyotrophy, insidious at the onset and located in the distal thigh and the proximal crus near the knee, slowly progressive weakness, and wasting of his right gastrocnemius muscle for the last 20 years.Diagnoses:He was diagnosed with MMA by the clinical profile, natural history, examinations, and the biopsy.Interventions:We perform dynamic physical therapy for the patient in this case.Outcomes:The positive effects of dynamic physical therapy in this case with MMA were shown in this report.Lessons:The outcome of physical therapy is satisfactory.

Purpose This paper aimed to study the method and outcome of antegrade elastic stable intramedullary nailing (ESIN) for irreducible distal radius fractures in diaphyseal-metaphyseal junction in children. Methods 27 irreducible distal radius fractures in children ranging in age from six to 13 years treated with closed reduction and antegrade ESIN from March 2017 to September 2018 were analyzed retrospectively. The series comprised 24 boys and three girls. 17 cases were double fractures in forearms and ten cases were single fractures of radius. Each case was treated with closed reduction, internal fixation of antegrade ESIN and plaster cast. ESIN was removed when fracture healed and remodelled well. Cooney modified Green-O'Brien wrist score was used to evaluate the wrist function. Ranges of motion (ROM) in bilateral wrists were contrasted at the final follow-up. P<0.05 was considered statistically significant in the difference. Results All the fractures healed four to six weeks post-operative. At the final follow-up (12-16 months), there was no statistical significance in ROM of bilateral wrists (all p>0.05). The mean Cooney modified Green-O'Brien wrist score was 93 (80-100) including 25 excellent (93%) and two good (7%) results. Conclusions The technique of antegrade ESIN is effective and minimal invasive for irreducible distal radius fractures in children. The criterion of proximal radius approach to implant ESIN should be studied further in minimal invasive therapy of fractures.