ObjectiveTo investigate the role of the forkhead/Fox transcription factor 2 (Foxc2) over-expression in regulating osteogenic differentiation of bone marrow mesenchymal stem cells (BMSCs) by Wnt-β-catenin signaling pathways in vitro so as to provide the experimental basis for repairing osteonecrosis of the femoral head. MethodsThe recombinant lentivirus carrying green fluorescent protein (group A) or Foxc2 (group B) were used to transfect the fifth generation rabbit BMSCs, and untransfected BMSCs served as a control (group C). The cell viability was measured with water soluble tetrazolium-1 (WST-1) regent at 72 hours after transfection. After 2 weeks of transfection, the expression of β-catenin in BMSCs was detected by real time fluorescence quantitative PCR, Western blot, and immunofluorescence staining. Meanwhile, the β-catenin inhibitors XAV-939 (0, 0.1, and 1.0 μmol/L) was added in group B; at 2 weeks after osteogenic and adipogenic induction, the gene and protein expressions of collagen type I (COL I), osteocalcin (OCN), and peroxisome proliferator activated receptor gamma 2 (PPARγ-2) were detected by real time PCR and Western blot. ResultsWST-1 results showed that the cell viability of group B (130.85%±0.15%) was significantly higher than that of group A (100.45%±0.35%) (t=7.500, P=0.004) at 72 hours after transfection. At 2 weeks after transfection, the gene and protein expressions of β-catenin in group B were significantly higher than those in group A (P<0.01). After XAV-939 was added in group B, the mRNA and protein expressions of OCN and COL I gradually decreased; the mRNA and protein expressions of PPARγ-2 significantly increased (P<0.05), showing a dose-dependent manner. ConclusionThe over-expression of Foxc2 gene in BMSCs may promote osteogenic differentiation by Wnt-β-catenin signaling pathway.
ObjectiveTo investigate the effect of microencapsulated transgenic bone marrow mesenchymal stem cells (BMSCs) transplantation on early steroid induced osteonecrosis of femoral head (SONFH) in rabbits.MethodsAlginate poly-L-lysine-sodium alginate (APA) microencapsulated transgenic BMSCs with high expression of Foxc2 were prepared by high-voltage electrostatic method. Part of the cells were cultured in osteoblasts and observed by alizarin red staining at 2 and 3 weeks. Forty New Zealand white rabbits were used to prepare SONFH models by using hormone and endotoxin. Thirty two rabbits who were successful modeling were screened out by MRI and randomly divided into 4 groups (groups A, B, C and D, n=8); another 6 normal rabbits were taken as normal control (group E). The rabbits in group A did not receive any treatment; and in groups B, C, and D were injected with normal saline, allogeneic BMSCs, and APA microencapsulated transgenic BMSCs respectively after core decompression. At 6 and 12 weeks after operation, specimens of femoral head were taken for HE staining to observe bone ingrowth; the expressions of osteocalcin (OCN), peroxisome proliferative activated receptor γ 2 (PPARγ-2), and vascular endothelial growth factor (VEGF) proteins were observed by immunohistochemistry staining. At 12 weeks after operation, the bone microstructure was observed by transmission electron microscope, and the maximum compressive strength and average elastic modulus of cancellous bone and subchondral bone were measured by biomechanics.ResultsAfter 2 and 3 weeks of induction culture, alizarin red staining showed the formation of calcium nodules, and the number of calcium nodules increased at 3 weeks when compared with 2 weeks. The rabbits in each group survived until the experiment was completed. Compared with groups A, B, and C, the trabeculae of group D were more orderly, the empty bone lacunae were less, there were abundant functional organelles, and obvious osteogenesis was observed, and the necrotic area was completely repaired at 12 weeks. Immunohistochemical staining showed that, at 6 and 12 weeks after operation, the expressions of OCN and VEGF in groups A, B, and C were significantly lower than those in groups D and E, while those in groups B and C were significantly higher than those in group A, and in group E than in group D (P<0.05). The expression of PPARγ-2 was significantly higher in groups A, B, and C than in groups D and E, and in group A than in groups B and C, and in group D than in group E (P<0.05). At 12 weeks after operation, biomechanical test showed that the average elastic modulus and maximum compressive strength of cancellous bone and subchondral bone in groups D and E were significantly higher than those in groups A, B, and C (P<0.05); there was no significant difference between groups A, B, and C and between groups D and E (P>0.05).ConclusionIn vivo transplantation of microencapsulated transgenic BMSCs can repair early SONFH in rabbits.
ObjectiveTo review the effects and mechanisms of various myokines secreted by skeletal muscle on various bone tissue cells.MethodsLiterature related to myokines and their regulation of bone tissue cells was reviewed and analyzed comprehensively in recent years.ResultsBone and skeletal muscle are important members of the motor system, and they are closely related in anatomy, genetics, and physiopathology. In recent years, it has been found that skeletal muscle can secrete a variety of myokines to regulate bone marrow mesenchymal stem cells, osteoblasts, osteoclasts, and bone cells; these factors mutual crosstalk between myoskeletal unit, contact each other and influence each other, forming a complex myoskeletal micro-environment, and to some extent, it has a positive impact on bone repair and reconstruction.ConclusionMyokines are potential targets for the dynamic balance of bone tissue cells. In-depth study of its mechanism is helpful to the prevention and treatment of myoskeletal diseases.
Objective To investigate the correlation of microperimetric parameters, best-corrected visual acuity (BCVA) and central retinal thickness (CRT) in diabetic macular edema (DME) eyes. Methods It is a prospective, no controlled, open study. Twenty-four consecutive patients (40 eyes) with DME were included. There were 10 males (18 eyes),14 females (22 eyes); aged from 41 to 79 years, with the mean age of (56.84±8.96) years. All the patients were type 2 diabetes, the average duration of diabetes was 8 years. BCVA was evaluated using the international Snellen E vision test chart, and then recorded as logarithm of the minimum angle of resolution (logMAR). CRT was measured by Cirrus HD-OCT4000. MAIA microperimetric parameters were evaluated, including average threshold (AT) of retinal sensitivity, macular integrity index (MI), fixating points within a circle of 1° (P1) and 2° of radius (P2), bivariate contour ellipse area (BCEA) considering 63% and 95% of fixating points (A63,A95), and horizontal and vertical axes of that ellipse (H63,H95,V63,V95). Pearson correlation analysis was performed to evaluate the association between these variables. The independent factor influenced the type of fixation was analyzed by multiple linear regression analysis. Results Strong correlations of logMAR BCVA with CRT (r=0.58,P=0.000), V63 (r=0.44,P=0.004), V95 (r=0.41,P=0.008), MI (r=0.36,P=0.024), AT (r=−0.61,P=0.000), P1 (r=−0.41,P=0.009), P2 (r=−0.38,P=0.015) were found. AT was correlations with P1 (r=0.53,P=0.000), P2 (r=0.51,P=0.001), A63 (r=−0.39,P=0.012), A95 (r=−0.40,P=0.012), V63 (r=−0.53,P=0.000), V95 (r=−0.46,P=0.003), MI (r=−0.50,P=0.001). There was no correlation between AT and CRT (r=−0.21,P=0.190). Forty eyes were included in this study, 8 eyes (20%) had stable fixation,14 eyes (35%) had relatively unstable fixation,18 eyes (45%) had unstable fixation. Multiple linear regression analysis showed that fixation classification was independently affected by P1. Conclusions In DME eyes, logMAR BCVA was positively correlated with CRT, negatively correlated with AT, P1 and P2. There is no correlation between AT and CRT. The fixation classification was independently affected by P1.
Objective To assess the effectiveness of arthroscopic capsular release to treat primary severe frozen shoulder through trans cuff portal. Methods Between June 2012 and January 2015, 28 patients with primary severe frozen shoulder were enrolled in the study. There were 8 males and 20 females with an average age of 57 years (range, 42-81 years). The left shoulder was involved in 16 cases and the right one in 12 cases. The mean disease duration was 11 months (range, 7-21 months). Six patients had diabetes. All patients underwent arthroscopic capsular release by trans cuff portal. The range of motion (ROM) of the shoulder were measured at preoperation and at 6 weeks and 24 months after operation; the scores of American Shoulder and Elbow Surgeons (ASES) and visual analogue scale (VAS) were used to evaluate the shoulder function and pain. Results Primary healing of incision was obtained, and no complications of infection, shoulder instability, and nerve injury were found. All patients were followed up 24 months. Pain of the shoulder was obviously relieved; VAS score was significantly lower at 6 weeks and 24 months after operation than preoperation (P<0.05), and at 24 months than 6 weeks (P<0.05). ROM of the shoulder and ASES score at 6 weeks and 24 months after operation were significantly increased when compared with preoperative ones (P<0.05); significant difference was found in ROM of forward flexion and external rotation and the ASES score between at 6 weeks and 24 months (P<0.05). And internal rotation in-creased from trochanter (9 cases), hip (6 cases), sacrum (7 cases), and L4 vertebral level (6 cases) before operation to the T12-T6 vertebral level at 6 weeks and 24 months after operation, which were close to normal side. Conclusion Arthroscopic capsular release through trans cuff portal is an effective and safe management for primary severe frozen shoulder.
ObjectiveTo investigate the effectiveness of percutaneous compression plate (PCCP) fixation for femoral neck fracture.MethodsA clinical data of 100 patients with femoral neck fractures who were treated with internal fixation were analyzed retrospectively. The fractures were fixed with the cannulated screws (CS) in 55 patients (CS group) and with the PCCP in 45 patients (PCCP group). There was no significant difference in gender, age, the cause of injury, the fracture type, complications, and disease duration between the two groups (P>0.05). The quality of fracture reduction, bone resorption, screw slipping, femoral neck shortening, complications (nonunion, failure of fixation, and osteonecrosis of femoral head), and functional recovery of hip (Harris score) were compared between the two groups.ResultsAll incisions healed by first intention. All patients were followed up 24-56 months, with an average of 30.7 months. The quality of fracture reduction was excellent in 26 cases, good in 18 cases, fair in 9 cases, and poor in 2 cases in CS group and excellent in 21 cases, good in 17 cases, fair in 4 cases, and poor in 3 cases in PCCP group, showing no significant difference between the two groups (Z=−0.283, P=0.773). The incidence of nonunion in PCCP group was significantly lower than that in CS group (P=0.046), and the fracture healing time in PCCP group was shorter than that in CS group (t=2.155, P=0.034). There was no significant difference in the incidences of bone resorption, screw slipping, femoral neck shortening, failure of fixation, and osteonecrosis of femoral head between the two groups (P>0.05). The overall complication rates were 27.27% (15/55) in CS group and 8.89% (4/45) in PCCP group, showing significant difference (χ2=5.435, P=0.020). The Harris score in PCCP group at 6 months after operation was significantly higher than that in CS group (t=−2.073, P=0.041). However, there was no significant difference in the Harris score at 12, 18, and 24 months after operation between the two groups (P>0.05).ConclusionStable sliding compression of PCCP is benefit for the femoral neck fracture healing, especially shortening union.
Objective To study the feasibility of virtual intercondylar notchplasty by applying MRI two-dimensional (2D) images to reconstruct three-dimensional (3D) images and measure the size of intercondylar notch. Methods Thirty healthy volunteers who had no knee joint disease and surgery history were selected. There were 15 females and 15 males with an age range of 20-30 years, weight range of 45-74 kg, and height range of 150-185 cm. They were divided into male group and female group, and the knees of each group were divided into 2 subgroups (the left group and right group). MRI scan of the left and right knees was performed, and the 2D images of MRI were imported into Mimics10.01 medical image control system for 3D reconstruction. The related anatomical data as follows were measured from the 3D digital model and analyzed by statistical software: notch width (NW), condylar width (CW), and notch width index (NWI). Then the 3D knee images of patients with anterior cruciate ligament (ACL) injury were collected between January and March 2010, and 4 patients with narrow intercondylar notch (NWI≤0.2) were selected for reconstructing the 3D model of the knee and simulating the intercondylar notch plasty. Then, the volume of osteotomy in 3D model was calculated and applied in the ACL reconstruction surgery, and whether the graft had impingement with intercondylar notch or not was evaluated. Results There were significant differences in NW and CW between male group and female group (P≤lt;≤0.05), but no significant difference was found in the NWI (P≤gt;≤0.05). And there was no significant difference in NW, CW, and NWI between the left and right knees both in male group and female group (P≤gt;≤0.05). After ACL reconstruction and intercondylar notchplasty, the shape of intercondylar notch became normal (NWI≤gt;≤0.22), no impingement occurred between the graft and intercondylar notch under arthroscopy within 3-month follow-up. Conclusion The shape of intercondylar notch of 3D model based on MRI 2D images is similar to the real intercondylar notch. NWI is one of important indexes which can reflect the narrow level of intercondylar notch. The virtual intercondylar notchplasty may provide preoperative plan and guidence for ACL reconstruction operation to avoid the impingement between graft and intercondylar notch after surgery.
ObjectiveTo compare the recovery of proprioception of the knee after the anterior cruciate ligament (ACL) reconstruction with remnant preservation or not. MethodsBetween January 2010 and October 2012, 40 patients with ACL rupture were divided into remnant preservation reconstruction group (trial group, n=20) and traditional reconstruction group (control group, n=20). There was no significant difference in gender, age, disease duration, injury causes, preoperative Lysholm scores, and preoperative International Knee Documentation Committee (IKDC) scores between 2 groups (P>0.05). All the patients received ACL single-bundle reconstruction surgery with autologous hamstring tendon transplantation under arthroscope. After operation, the function of knee was assessed by Lysholm and IKDC scores and the proprioception was assessed by joint position sense (JPS) value which was evaluated by passive repeat angle test with isokinetic test system. ResultsAll incisions healed by first intention in 2 groups. The patients were followed up 12-16 months (mean, 14.0 months) in trial group, and 12-15 months (mean, 14.5 months) in control group. At 12 months after operation, the Lysholm and IKDC scores were significantly increased when compared with preoperative scores (P<0.05) in both groups, but no significant difference was found between 2 groups (P>0.05). At 3 months and 12 months after operation in trial group, the JPS values of operated knee at 15, 45, and 75° of flexion were significantly lower than preoperative values (P<0.05), but no significant difference was found between at 3 months and at 12 months after operation (P>0.05). At 3 months after operation in control group, there was no significant difference (P>0.05) in JPS values of operated knee at 15, 45, and 75° of flexion when compared with preoperative ones; but at 12 months after operation in control group, the JPS values of operated knee at 15, 45, and 75° of flexion were significantly lower than those at preoperation and at 3 months after operation (P<0.05). At 3 months after operation, the JPS of operated knee at 15, 45, and 75° of flexion in trial group were significantly lower than those of operated knee in control group (P<0.05), but no significant difference was found between 2 groups at 12 months after operation (P>0.05). At 3 and 12 months after operation in trial group, there was no significant difference (P>0.05) in JPS values at 15, 45, and 75° of flexion between operated and normal knees; at 3 months after operation in control group, the JPS values of operated knee at 15, 45, and 75° of flexion were significantly higher than those of normal knee, but there was no significant difference between operated knee and normal knee at 12 months after operation (P>0.05). ConclusionACL reconstruction with remnant preservation is helpful for recovery of proprioception in knee joint at early stage.
目的 总结法洛四联症矫治术的临床经验，进一步提高治愈率，降低其并发症和死亡率。 方法 回顾性分析2005年4月1日至2013年3月31日河南省胸科医院704例行法洛四联症矫治术患者的临床资料，其中男394例、女310例，年龄3个月至45岁，平均（3.6±6.6）岁。 结果 684 （97.20%） 例治愈，死亡20例，死亡率2.8%。死于低心排血量综合征和多器官功能衰竭16例，急性肾功能衰竭2例，术后灌注肺合并肺部感染1例，心搏骤停1例。因术后出血量多，再次开胸止血21例（2.98%）；脱离呼吸机后二次气管内插管21例（2.98%），腹膜透析治疗肾功能不全25例，发生感染性心内膜炎10例，Ⅲ°房室传导阻滞2例；10例术后出院前复查发现小的室间隔缺损残余漏，5例跨肺动脉瓣压差超过40 mm Hg。随访1～8年，随访到658例，随访率98%。随访期间因心衰死亡3例，因心内膜炎死亡1例。 结论 术前精确诊断，把握好手术适应证，术中矫治满意，术后及时恰当处理是手术成功的关键。