Objective To investigate the effect of dynamic compression and rotation motion on chondrogenesis of the 3rd passage cell-loaded three-dimensional scaffold in a joint-specific bioreactor in vitro so as to provide theoretical basis of the autologous chondrocyte transplantation in clinical practice. Methods Primary chondrocytes were isolated and cultured from the knee cartilage of 3-4 months old calves. The 3rd passage cells were seeded onto fibrin-polyurethane scaffolds (8 mm × 4 mm). Experiment included 5 groups: unloaded culture for 2 weeks (group A), direct load for 2 weeks (group B), unloaded culture for 4 weeks (group C), direct load for 4 weeks (group D), and unload for 2 weeks followed by load for 2 weeks (group E). The cell-scaffold was incubated in incubator (unload) or in a joint-specific bioreactor (load culture). At different time points, the samples were collected for DNA and glycosaminoglycan (GAG) quantification detect; mRNA expressions of chondrogenic marker genes such as collagen type I, collagen type II, Aggrecan, cartilage oligomeric matrix protein (COMP), and superficial zone protein (SZP) were detected by real-time quantitative PCR; and histology observations were done by toluidine blue staining and immunohistochemistry staining. Results No significant difference was found in DNA content, GAG content, and the ratio of GAG to DNA among 5 groups (P gt; 0.05). After load, there was a large number of GAG in the medium, and the GAG significantly increased with time (P lt; 0.05). The mRNA expression of collagen type I showed no significant difference among 5 groups (P gt; 0.05). The mRNA expression of collagen type II in group B was significantly increased when compared with group A (P lt; 0.01), and groups D and E were significantly higher than group C (P lt; 0.01); the mRNA expression of Aggrecan in groups D and E were significantly increased when compared with group C (P lt; 0.01), and group E was significantly higher than group D (P lt; 0.01); the mRNA expression of COMP in group B was significantly increased when compared with group A (P lt; 0.01), and group E was significantly higher than group C (P lt; 0.01); and the mRNA expression of SZP in group E was significantly increased when compared with groups C and D (P lt; 0.05). The toluidine blue staining and immunohistochemistry staining displayed that synthesis and secretion of GAG could be enhanced after load; no intensity changes of collagen type I and collagen type II were observed, but intensity enhancement of Agrrecan was seen in groups D and E. Conclusion Different dynamic loads can promote chondrogenesis of the 3rd passage chondrocytes. Culture by load after unload may be the best culture for chondrogenesis, while the 3rd passage chondrocytes induced by mechanical load hold less capacity of chondrogenesis.
【Abstract】 Objective To explore the midterm efficacy of superelastic cage implantation for the treatment of osteonecrosisof femoral head (ONFH). Methods From July 1996 to January 1998, 54 patients (75 hips) of ONFH were treatedwith superelastic cage and followed up. Among 54 patients, 5 patients were lost to follow up and 3 patients were dead of myocardialinfarction, renal failure and gastric cancer, respectively. Forty-six patients completed follow up including 32 males and14 females, aged from 21 to 61 with an average of 39 years old. Twenty-nine hips were classified as Ficat Stage Ⅱ and 36 as StageⅢ . Harris score was 58.20 ± 13.82. All patients were evaluated both cl inically and radiographically. Results Postoperatively,forty-six patients (65 hips) were followed up for 86 to 125 months with an average of 8 years and 8 months. Harris score was 80.78 ± 18.77. Twenty-nine hips were rated excellent, 21 good, 2 fair and 13 poor．A total of 76.9% of overall cl inical results were rated as good or excellent. Eight hips (12.3%) with the cage broken were turned to total hip replacement. Radiographicevaluation: 16 hips (24.6%) rated as grade Ⅰ , 34 (52.3%) grade Ⅱ and 15 (23.1%) grade Ⅲ . Conclusion Superelastic cage implantation is one of alternative treatments for ONFH at early and midterm stages. However, long-term follow-up is needed to know whether it is able to cure ONFH and whether cages will be broken as time passes by.
Objective To provide references and recommendations about emergency physician training for our country by analyzing the characteristics of emergency physicians training objective, subject, process, content, appraisal and assessment in the United States, the United Kingdom, Canada and Australia. Methods Such databases as Ovid, Proquest, MDConsoult and relevant websites of national emergency medicine were searched to include literature covering guidelines and documents on emergency education and training in the United States, the United Kingdom, Canada and Australia. According to the evidence-based scientific principles and methods, we graded and analyzed the included information. Results A total of 40 articles were included, covering 12 guidelines and documents, 2 reviews and 26 research documents. Each of the four countries owned a sound emergency specialist training access system especially on how they used competency as the core to design the training content, courses and appraisal and assessment system to improve overall ability and quality of emergency physicians. Conclusion Our country’s emergency physician training certainly has lagged behind those of the developed countries. We should learn from positive experience of the developed countries to standardize emergency physician training, improve the emergency physician training content and curriculum, strengthen access management and the construction of appraisal system, and cultivate the competency of emergency physicians.
ObjectiveTo systematically review the relationship between Glasgow prognostic score (GPS) and prognosis of gastric cancer (GC) patients. MethodsPubMed, Web of Science, The Cochrane Library, CNKI, CBM and VIP databases were electronically searched to collect cohort studies on the relationship between GPS and prognosis of GC patients from inception to April, 2022. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies; then, meta-analysis was performed by using RevMan 5.3 software and Stata 16.0 software. ResultsA total of 9 cohort studies involving 2 395 patients were included. The results of meta-analysis showed that GPS was significantly associated with poor overall survival of GC patients (HR=2.01, 95%CI 1.55 to 2.61, P<0.000 01). It also was associated with deeper depth of tumor, positive lymph node metastasis, more advanced TNM stages, positive distant metastasis and older age. ConclusionCurrent evidence shows that GPS is associated with survival prognosis and clinical pathological features of GC patients. Due to limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusion.
Objective To investigate the effectiveness of total hip arthroplasty with double-tapered cementless femoral stem for hip bony fusion by comparing with anatomical cementless femoral stem. Methods A retrospective analysis was made on clinical data of 50 cases (80 hips) of hip bony fusion undergoing total hip arthroplasty between October 1999 and January 2008. The patients were divided into 2 groups: 31 cases (49 hips) using BetaCone double-tapered cementless femoral stem (trial group), and 19 cases (31 hips) using Ribbed anatomical cementless femoral stem (control group). There was no significant difference in gender, age, disease duration, preoperative Harris score, and abduction angle of the hip between 2 groups (P gt; 0.05). After operation, X-ray films were used to calculate the ratio of force arm of abductor (a) to the force arm of gravity (b) and analyze the stability of the prosthesis. The abduction angle of the hip and Harris score were measured during follow-up. Results Fracture occurred during operation in 9 hips of 9 cases (5 in trial group and 4 in control group), and was cured after fixation. The mean follow-up time was 49 months (range, 12-98 months) in trial group and was 53 months (range, 6-105 months) in control group. The ratio of a/b was 0.65 ± 0.25 in trial group and was 0.56 ± 0.37 in control group, showing significant difference (t=2.19, P=0.03). The abduction angle of hip was (34.49 ± 7.58)° in trial group and was (30.97 ± 7.24)° in control group at 6 months after operation, which was significantly improved when compared with preoperative value in 2 groups (P lt; 0.05), and significant difference was found between 2 groups (t=2.06, P=0.04). Postoperative Harris score was significantly improved in 2 groups when compared with preoperative score (P lt; 0.05); trial group was better than control group in Harris score at 1 month after operation (t=3.62, P=0.01), but no significant difference was found between 2 groups at last follow-up (t=1.61, P=0.11). At last follow-up, X-ray films showed stabilized prosthesis in 2 groups. Grade I or II ectopic ossification occurred in 12 cases (14 hips) of trial group and 8 cases (9 hips) of control group at 2 years after operation. Conclusion The total hip arthroplasty with both double-tapered and anatomical cementless femoral stems for hip bony fusion can obtain satisfactory effectiveness, while the double-tapered cementless femoral stem has better abduction angle of hip.