ObjectiveTo isolate and culture cartilage derived stem cells from different subtypes of cartilages, and to identify their characteristics. MethodsCartilage derived stem cells were isolated from different subtypes of cartilages (auricle cartilage, articular cartilage, and intervertebral cartilage) by using adhesive method of fibronectin. The expressions of positive surface markers (CD29 and CD90) and negative surface markers (CD34 and CD45) in cartilage derived stem cells were detected via flow cytometry. The single cell colony-forming efficiency of cartilage derived stem cells was determined by clonal formation unit test; the multipotent differentiation capacity was identified by chondrogensis, osteogenesis, and adipogenesis induction. RT-PCR was used to test the expression of osteogenic, chondrogenic, and adipogenic genes; and bone marrow mesenchymal stem cells (BMSCs) served as control. ResultsThree cell populations were successfully isolated from different subtypes of cartilages, which could express CD29 and CD 90 highly, but did not express CD34 and CD45. After 2 weeks of culture, single cartilage derived stem cell could form single cell colony. In addition, cartilage derived stem cells had high chondrogenesis, osteogenesis, and adipogenesis potentials. After osteogenic induction, the expressions of collagen type Ⅰ and collagen type X in articular and intervertebral cartilage stem cells were significantly higher than those in BMSCs (P<0.05), while there was no significant difference between auricular cartilage stem cells and BMSCs (P>0.05). The expressions of Aggrecan and collagen type Ⅱ in cartilage derived stem cells after chondrogenic induction were significantly higher than those in BMSCs (P<0.05). While the ability of adipogenic differentiation was lower than that in BMSCs, but no significant difference was found (P>0.05). ConclusionCartilage derived stem cells in different subtypes of cartilages possess typical characteristics of stem cells.
ObjectiveTo explore the effectiveness of lamividine (LAM) combined with adefovir (ADV) versus entecavir (ETV) for lamivudine-resistant (LAM-R) hepatitis B in renal transplant recipients. MethodOutpatients and inpatients of lamivudine-resistant kidney graft recipients with chronic hepatitis B admitted to West China Hospital and the People's Hospital of Santai County during Jan 2007 to Mar 2012 were divided into A group (LAM+ADV) and B group (ETV). And the level of alanine aminotransferase (ALT), level of serum creatinine, HBV serological markers and HBV-DNA load were compared by SPSS 16.0 software. ResultsA total of 15 patients were included. The mean age was 36.7±6.6 years old, the majority of patients were male. After treatment for 4 weeks, 12 weeks, 24 weeks, 48 weeks, 96 weeks, no significant differences were found between two groups in liver function normalization rates, the HBV-DNA negative conversion rates and serum creatinine level. ConclusionsLAM add-on ADV combination therapy and ETV monotherapy were both safe and effective in LAM-R kidney transplants with CHB, but the load of HBV-DNA in some patients were still positive at the endpoint. Elevated serum creatinine level may occur in some patients who treated with ADV. Consequently, for HBsAg-positive kidney transplantation patients, those anti-HBV drugs that are more effective, safer and less resistant may be better in the beginning of treatment.
ObjectiveTo investigate the clinical features of elderly hip fracture in Leshan area in China. MethodsThe clinical data of patients with hip fractures from June 2006 to January 2013 were retrospectively analyzed. Gender, age, fracture type, injury causes, activities before injury and treatment were analyzed. ResultsThe mean age of patients with a hip fracture was 76.5 years. The overall male to female ratio with hip fracture was 1:1.44. There were 154 patients (50.0%) with femoral neck fracture, 138 patients (44.8%) with intertrochanteric fracture, and 16 patients (5.2%) with subrtrochanteric fracture. A total of 248 patients (77.3%) were poorly educated, and 210 patients (68.2%) had basic medical insurance. The mean time between being injured and hospitalized after injury was 3 days. There were 257 patients (83.4%) with fall damage. ConclusionFemale patients with hip fracture are more than male patients. Fall damage is the main injure type. The features of elderly hip fracture in Leshan include retardation to consult a doctor, poor education of the patients, dependence primarily on basic medical insurance and under-emphasis of anti-osteoporosis therapy.
ObjectiveTo introduce the clinical pathway for geriatric hip fracture regulated by our hospital and report the five-year outcomes after the implementation of the pathway. MethodsThe geriatric hip fracture patients treated between September 2003 and August 2012 were followed up. We did not implement the clinical pathway until January 2007. Statistical analysis was done to evaluate the effect of the clinical pathway on patient outcomes by comparing rate of complication, mortality, and length of hospital stay before and after the implementation of the clinical pathway. ResultsAfter the implementation of the pathway, the in-hospital mortality, one-year mortality and the rate of complication were significantly lower. Besides, the time from admission to operation and the total length of stay in hospital were obviously shortened. ConclusionThe use of clinical pathway for geriatric hip fracture can reduce the rate of complication and mortality, and shorten hospital stay, and the five-year outcomes after the implementation of the pathway are satisfying.
ObjectiveTo compare extra-articular and intra-articular olecranon osteotomy in treating intercondylar fractures of the distal humerus managed with open reduction and internal fixation regarding the functional outcomes and complications. MethodsBetween September 2008 and December 2010, 36 patients with intercondylar fractures of the distal humerus were treated by open reduction and internal fixation using the trans-olecranon approach. Among the, 21 underwent extra-articular olecranon osteotomy and 15 accepted intra-articular olecranon osteotomy. The mean follow-up time was three years. We compared the elbow function, the rate of no non-union or delayed union and the rate of postoperative complications between the two groups. ResultsThe elbow function and Mayo elbow performance scores were good at the latest follow-up. There was no non-union in all osteotomies. We found significant difference in delayed union (P=0.01) and traumatic arthritis rate (P=0.02) between the two groups. ConclusionExtra-articular olecranon osteotomy is better for bone union and the decrease of traumatic arthritis rate.
ObjectiveTo investigate the clinical outcome of arthroscopic synovectomy for inpatients with rheumatoid knee. MethodsArthroscopic synovectomy was performed on 32 rheumatoid knees in 31 patients, including 10 males and 21 females with an average age of (35.5±8.7) years (23 to 51 years) between January 2009 and March 2013. The patients' mean morbidity duration was (12.0±5.5) years (5 to 21 years). X-ray examination results were observed before the operation, 1 year and 2 years after the operation, and then Larsen method was used for assessment. Pain alleviation, C-reactive protein (CRP), rheumatoid factors (RF), and erythrocyte sedimentation rate (ESR) were compared before and after operation. ResultsThe follow-up averaged 1.7 years, and the average pain score decreased from 4.23±0.96 before surgery to 2.21±0.87 one year after surgery; RF decreased from (265.3±120.1) U/mL to (89.2±12.1) U/mL; CRP decreased from (89.36±32.12) mg/L to (20.12±10.21) mg/L; and ESR decreased from (86.56±12.32) mm/h to (45.23±11.12) mm/h. ConclusionArthroscopic synovectomy can effectively relieve pain and delay radiologic progression in patients with rheumatoid knees.
ObjectiveTo compare the early clinical outcome of GenesisⅡ high-flexion versus standard prostheses in total knee arthroplasty (TKA), and evaluate whether high-flexion prostheses can improve the postoperative range of motion (ROM). MethodsBetween September 2007 and December 2011, 80 patients (85 knees) consecutively underwent posterior cruciate-sacrificing TKA with GenesisⅡ systems. Finally, we reviewed 60 patients (60 knees) including 32 knees in high-flexion group and 28 knees in standard group. The follow-up time was 2.7 years in average. The postoperative knee ROM and the rate of complication of the two groups were evaluated. ResultsThe mean postoperative knee ROM of 32 knees was 112.8° in the high-flexion group and was 108.9° in the standard group. The mean postoperative HSS score was 86.6 and 84.2, respectively. The postoperative knee ROM, hospital for special surgery (HSS) score and the rate of complication did not show significant difference between the two groups. ConclusionThe high-flexion prosthesis is no better than the ordinary prosthesis in terms of the range of motion. We need more mid to long-term studies to do further research.
ObjectiveTo explore the therapeutic effect of using locking compression plate (LCP) as an external fixator and using an external fixator on open fractures of the tibia. MethodsBetween September 2010 and December 2012, 56 patients with the open tibia fractures underwent external fixation using LCP as an external fixator (LCP group, n=22) or external fixator (external fixator group, n=34). We compared the healing time, the rate of postoperative complication and the postoperative function between two groups. ResultsThe mean healing time was 11 weeks (8-28 weeks) and there was 1 case of delayed healing in the LCP group. The mean healing time was 14 weeks and there was 4 cases of delayed healing in the external fixator group. We found significant difference in the healing time (t=2.740, P=0.008) and the infection rate of pin track (13.6% vs 32.4%; χ2=2.496, P=0.114) between the LCP and external fixator group. ConclusionFor open fractures of the tibia, using LCP as an external fixator may increase the healing time and decrease the rate of postoperative complications.
ObjectiveTo compare the knee flexion degree after high-flexion versus standard total knee arthroplasty (TKA). MethodRelevant randomized controlled trials on comparison of knee flexion degree after high-flexion versus standard TKA were identified from Cochrane Library, PubMed, Embase, China National Knowledge Infrastructure from the establishment of these databases until October 2015. A systematic review was performed to compare knee flexion degree, knee function score and complications between the two types of prostheses. Analyses were conducted using RevMan version 5.2.0 software. ResultsTwenty-one studies were included in this Meta-analysis. The results showed that the knee flexion degree was higher in high-flexion group than that in the standard group[WMD=2.71°, 95%CI (0.96, 4.46)°, P=0.002]; while the difference was not significant leaving out six low-quality literatures[WMD=0.72°, 95%CI (-0.15, 1.60)°, P=0.10]. There was no significant difference in knee function score between the two groups[WMD=-0.54, 95%CI (-1.34, 0.25), P=0.18]. There was no significant difference in complications between the two groups[OR=0.99, 95%CI (0.53, 1.84), P=0.98]. ConclusionsThe important finding from the current study is that there is no evidence to support that the use of high-flexion prostheses is superior to the standard prostheses during total knee arthroplasty.
Modern medicine is being transferring from traditional "empirical medicine" to more scientific "evidence-based medicine", which embodies the idea that clinical research is a primary motive that keeps medical practice continuously developing. Therefore, the contemporary aim of medical education should focus on attaching great importance to and strengthen the training of medical students' clinical scientific research ability. Based on clinical departments, we have built an open research project platform for volunteers for medical students before engaging in medical practice. Through a spirally-progressing teaching mode of "Training-Practice-Assessment-Retraining" for medical students before engaging in medical practice, the platform provides training on the knowledge and skills of evidence-based medicine and clinical scientific research. Through the volunteers' active and omnibearing practice, this project achieves some good outcomes in teaching and learning experience. This extracurricular teaching mode provides a platform for scientific research volunteers with the capacity for more knowledge before engaging in medical practice, which is recommended to empower the students with ability of scientific research.