A microfluidics-derived growth factor gradient in a scaffold regulates stem cell activities for tendon-to-bone interface healing.

Treatment of tendon-to-bone interface injury has long been challenging in sports medicine. The major obstacle lies with the complicated three-layer structure of the tissue that consists of a bone region with osteocytes, a tendon region with tenocytes and a transitional region with chondrocytes. Conventional tissue engineering approaches using simply biomaterial scaffolds, stem cells and combinations of them had limited abilities to reconstruct the gradient structure with normal biomechanical properties. We herein aim to construct a three-layer structure with bone marrow-derived stem cells and tendon stem cells cultured in a decellularized tendon scaffold, through application of a gradient of biological cues in the longitudinal direction of the scaffold that guides the stem cells to differentiate and remodel the extracellular matrix in response to different medium concentrations in different regions. A microfluidic chip, on which a tree-like flow pattern was implemented, was adopted to create the concentration gradient in a dichotomous manner. We screened for an optimized seeding ratio between the two stem cell types before incubation of the scaffold in the medium concentration gradient and surgical implantation. Histology and immunohistochemistry assessments, both qualitatively and semi-quantitatively, showed that the microfluidic system provided desired guidance to the seeded stem cells that the healing at 8-week post-implantation presented a similar structure to that of a normal tendon-to-bone interface, which was outstanding compared to treatments without gradient guidance, stem cells or scaffolds where chaotic and fibrotic structures were obtained. This strategy offers a potentially translational tissue engineering approach for better outcomes in tendon-to-bone healing.

Conjoint analysis of lncRNA and mRNA expression in rotator cuff tendinopathy.

BACKGROUND: Rotator cuff tendinopathy (RCT) is a common musculoskeletal disorder in the shoulder, whose underlying mechanism is unknown. Long non-coding RNAs (lncRNAs) are involved in the development of various diseases, but little is known about their potential roles in RCT. METHODS: In this study, we profiled lncRNAs and mRNAs involved in RCT in comparison with the normal tendon (NT) by RNA sequencing (RNA-Seq), to identify potential therapeutic targets. Gene ontology (GO), Kyoto encyclopedia of genes and genomes (KEGG) pathway, competing endogenous RNA (ceRNA), and co-expression network construction were used to identify the potential functions of these RNAs. Three lncRNAs and three mRNAs were validated by quantitative reverse transcription-polymerase chain reaction (qRT-PCR). RESULTS: In total, 419 lncRNAs and 1,541 mRNAs were differentially expressed between the RCT and NT groups with a fold change of >2 and P of <0.01. The GO and KEGG pathway analyses showed that the differentially expressed mRNAs were mainly enriched in complement activation and involved in the citrate cycle. The ceRNA network showed the interaction of differentially expressed RNAs, comprising 139 lncRNAs, 126 mRNAs, and 35 miRNAs. NONHSAT209114.1, ENST00000577806, NONHSAT168464.1, PLK2, TMEM214, and IGF2 were validated by PCR. We constructed a co-expressed network of these validated RNAs. CONCLUSIONS: We preliminarily analyzed the profile of lncRNAs and mRNAs in RCT. The bioinformatic analysis revealed several potential therapeutic targets for RCT.

A biphasic, demineralized, and Decellularized allograft bone-hydrogel scaffold with a cell-based BMP-7 delivery system for osteochondral defect regeneration.

The reconstruction of bone and cartilage defects remains a challenge in orthopedics and tissue engineering. In this study, a mimetic natural scaffold based on a demineralized and decellularized bone and collagen type I (Col I) allograft was developed. The resulting hydrogel has the capability of loading allogeneic bone marrow mesenchymal stem cells (BMSCs) resulting in the sustained release of bone morphogenetic protein-7 (BMP-7). BMSCs transfected with lentivirus loaded with BMP-7 gene were used as the BMP-7 delivery system, and then seeded on a demineralized and decellularized allograft bone-collagen biphasic scaffold to enhance bone and cartilage regeneration. The results indicated that, after transfection, BMSCs had a higher expression of the BMP-7 gene and the sustained release of BMP-7 lasted more than 28 days. The preliminary biphasic scaffold promoted cell adhesion and proliferation. After implanting the transfected cells into the knee joints of beagle dogs, enhanced osteochondral defect regeneration was identified at 12 weeks postimplantation. Our results revealed that the new cell-loaded scaffold can avoid the side effects and the short half-life of BMP-7, and promote the reconstruction of bone and cartilage defects. Such a composite system, therefore, shows potential in bone and cartilage tissue engineering applications.

Aspirin promotes tenogenic differentiation of tendon stem cells and facilitates tendinopathy healing through regulating the GDF7/Smad1/5 signaling pathway.

Tendinopathy is a common musculoskeletal system disorder in sports medicine, but regeneration ability of injury tendon is limited. Tendon stem cells (TSCs) have shown the definitive treatment evidence for tendinopathy and tendon injuries due to their tenogenesis capacity. Aspirin, as the representative of nonsteroidal anti-inflammatory drugs for its anti-inflammatory and analgestic actions, has been commonly used in treating tendinopathy in clinical, but the effect of aspirin on tenogenesis of TSCs is unclear. We hypothesized that aspirin could promote injury tendon healing through inducing TSCs tenogenesis. The aim of the present study is to make clear the effect of aspirin on TSC tenogenesis and tendon healing in tendinopathy, and thus provide new treatment evidence and strategy of aspirin for clinical practice. First, TSCs were treated with aspirin under tenogenic medium for 3, 7, and 14 days. Sirius Red staining was performed to observe the TSC differentiation. Furthermore, RNA sequencing was utilized to screen out different genes between the induction group and aspirin treatment group. Then, we identified the filtrated molecules and compared their effect on tenogenesis and related signaling pathway. At last, we constructed the tendinopathy model and compared biomechanical changes after aspirin intake. From the results, we found that aspirin promoted tenogenesis of TSCs. RNA sequencing showed that growth differentiation factor 6 (GDF6), GDF7, and GDF11 were upregulated in induction medium with the aspirin group compared with the induction medium group. GDF7 increased tenogenesis and activated Smad1/5 signaling. In addition, aspirin increased the expression of TNC, TNMD, and Scx and biomechanical properties of the injured tendon. In conclusion, aspirin promoted TSC tenogenesis and tendinopathy healing through GDF7/Smad1/5 signaling, and this provided new treatment evidence of aspirin for tendinopathy and tendon injuries.

Clinical Efficacy of Three Surgical Approaches for the Treatment of Cervicothoracic Tuberculosis: A Multicenter Retrospective Study.

OBJECTIVE: To evaluate the efficacy of three surgical approaches for the treatment of cervicothoracic tuberculosis. METHODS: This is a multicenter retrospective study. We analyzed 74 patients with cervicothoracic tuberculosis who were treated in six institutions between January 2000 and January 2015. There were 37 male and 37 female patients, with an average age of 24 years (range, 5-62 years). The operative method was selected according to the indications. A total of 33 patients underwent one-stage anterior surgery (group A); 16 underwent a combined anterior and posterior surgery (group B) and 25 underwent one-stage posterior surgery (group C). Clinical outcomes, laboratory indexes, and radiological results were analyzed. RESULTS: All cases were followed up for approximately 36-96 months post-surgery (average, 39 months). At the last follow-up, patients in all three groups had achieved bone fusion, with pain relief and neurological recovery. No major vessel and nerve injuries were found during the operation. There were significant differences before and after treatment for visual analogue scale (VAS), neck disability index (NDI), and Japanese Orthopedic Association (JOA) score (P < 0.001). Three surgical strategies significantly improved kyphosis (P < 0.001). CONCLUSION: The choice of operation for cervicothoracic tuberculosis should be selected based on the pathological changes, scope, and general physical condition of the patient. The indication for a posterior approach is narrow and it should be used selectively. The combined anterior and posterior approach involved a longer operating time, larger blood loss, and greater trauma, and also required a higher level of surgical skill. Therefore, the indications for this approach should be strictly controlled. Anterior approach surgery for the treatment of cervicothoracic tuberculosis showed excellent efficacy and fewer complications.

Treatment of lumbosacral tuberculosis by anterior internal fixation combined with computed tomography angiography.

OBJECTIVE: This study aims to examine the iliac vascular space in patients with lumbosacral tuberculosis and to evaluate the feasibility of anterior internal fixation for lumbosacral tuberculosis. METHODS: A retrospective analysis was performed in 36 patients with lumbosacral tuberculosis. The preoperative three-dimensional computed tomography angiography images were analyzed for anatomical parameters. RESULTS: There were large variations among the anterior lumbosacral iliac vessels. Predominantly, the left iliac vein and the right iliac artery formed the two borders of the triangular iliac vascular space in the coronal plane. The mean distance between the iliac vessels straddle point and the inferior endplate of L5 was 15.01 ± 15.08 mm. In the sagittal plane, presacral abscess increased the distance between the posterior iliac vessel and the anterior vertebra. The distances on the left and right sides were 9.94 ± 6.03 and 10.15 ± 5.46 mm, respectively, at the inferior endplate of L5 and were 11.90 ± 6.97 and 11.68 ± 5.52 mm, respectively, at the superior endplate of S1. CONCLUSIONS: The space on sagittal plane occupied by presacral abscess may push forward the vessels and therefore provide opportunities for anterior internal fixation.

Aspirin inhibits inflammation and scar formation in the injury tendon healing through regulating JNK/STAT-3 signalling pathway.

OBJECTIVELY: Tendinopathy is a common problem in sports medicine which can lead to severe morbidity. Aspirin, as the classical representative of non-steroidal anti-inflammatory drugs (NSAIDs) for its anti-inflammatory and analgesic actions, has been commonly used in treating tendinopathy. While its treatment effects on injury tendon healing are lacking, illuminating the underlying mechanism may provide scientific basis for clinical treatment. MATERIALS AND METHODS: Firstly, we used immunohistochemistry and qRT-PCR to detect changes in CD14, CD206, iNOS, IL-6, IL-10, MMP-3, TIMP-3, Col-1a1, biglycan, Comp, Fibronectin, TGF-ß1，ACAN，EGR-1 and FMOD. Next, Western blot was used to measure the protein levels (IL-6, IL-10, TGF-ß1, COMP, TIMP-3, STAT-3/P-STAT-3 and JNK/P-JNK) in TSCs. Then, migration and proliferation of TSCs were measured through wound healing test and BrdU staining. Finally, the mechanical properties of injury tendon were detected. RESULTS: After aspirin treatment, the inflammation and scar formation in injury tendon were significantly inhibited by aspirin. Still, tendon's ECM was positively balanced. Increasing migration and proliferation ability of TSCs induced by IL-1ß were significantly reversed. JNK/STAT-3 signalling pathway participated in the process above. In addition, biomechanical properties of injury tendon were significantly improved. CONCLUSIONS: Taken together, the findings suggested that aspirin inhibited inflammation and scar formation via regulation of JNK/STAT-3 signalling and decreased rerupture risk of injury tendon. Aspirin could be an ideal therapeutic strategy in tendon injury healing.

Exosomes from tendon stem cells promote injury tendon healing through balancing synthesis and degradation of the tendon extracellular matrix.

Tendon injuries are common musculoskeletal system disorders in clinical, but the regeneration ability of tendon is limited. Tendon stem cells (TSCs) have shown promising effect on tissue engineering and been used for the treatment of tendon injury. Exosomes that serve as genetic information carriers have been implicated in many diseases and physiological processes, but effect of exosomes from TSCs on tendon injury repair is unclear. The aim of this study is to make clear that the effect of exosomes from TSCs on tendon injury healing. Exosomes were harvested from conditioned culture media of TSCs by a sequential centrifugation process. Rat Achilles tendon tendinopathy model was established by collagenase-I injection. This was followed by intra-Achilles-tendon injection with TSCs or exosomes. Tendon healing and matrix degradation were evaluated by histology analysis and biomechanical test at the post-injury 5 weeks. In vitro, TSCs treated with interleukin 1 beta were added by conditioned medium including exosomes or not, or by exosomes or not. Tendon matrix related markers and tenogenesis related markers were measured by immunostaining and western blot. We found that TSCs injection and exosomes injection significantly decreased matrix metalloproteinases (MMP)-3 expression, increased expression of tissue inhibitor of metalloproteinase-3 (TIMP-3) and Col-1a1, and increased biomechanical properties of the ultimate stress and maximum loading. In vitro, conditioned medium with exosomes and exosomes also significantly decreased MMP-3, and increased expression of tenomodulin, Col-1a1 and TIMP-3. Exosomes from TSCs could be an ideal therapeutic strategy in tendon injury healing for its balancing tendon extracellular matrix and promoting the tenogenesis of TSCs.

Single-stage posterior debridement, decompression and transpedicular screw fixation for the treatment of thoracolumbar junction (T12-L1) tuberculosis with associated neurological deficit: a multicentre retrospective study.

BACKGROUND: A multicentre retrospective study was conducted to evaluate the safety and efficacy of single-stage posterior debridement, decompression and transpedicular screw fixation for the treatment of thoracolumbar junction (T12-L1) tuberculosis in patients with associated neurological deficit. METHODS: Thoracolumbar junction (T12-L1) tuberculosis patients (n = 69) with neurological deficit who underwent single-stage posterior debridement, decompression and transpedicular screw fixation from January 2005 to January 2015 were included in the study. Antituberculosis therapy was performed both before and after surgery. The surgery duration and patient blood loss were evaluated, in addition to the change in pain visual analogue score (pVAS), kyphotic angle, Oswestry disability index (ODI) score and American Spinal Injury Association (ASIA) grade assessed preoperatively, immediate postoperatively and at the final follow-up visit. RESULTS: The average blood loss was 354 ± 291 mL. The average kyphosis angle was corrected from 21 ± 9° preoperatively to 9 ± 4° postoperatively, with a mean decrease in pVAS and ODI scores of 3.4 and 16, respectively. The postoperative ASIA grading was grade A for five patients, grade C for 15 and grade D for 49 patients, which had improved to grade C for four patients, grade D for three patients and grade E for 62 patients at the final follow-up. The neurological deficit did not worsen in any of the patients. CONCLUSIONS: Single-stage posterior debridement, decompression and transpedicular screw fixation is an effective treatment method in thoracolumbar junction (T12-L1) tuberculosis patients with neurological deficit, with good neurological recovery and no progression of kyphosis.

High Concentration of Aspirin Induces Apoptosis in Rat Tendon Stem Cells via Inhibition of the Wnt/ß-Catenin Pathway.

BACKGROUND/AIMS: Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used in clinical practice to relieve fever and pain. Aspirin, as a representative NSAID, has been widely used in the treatment of tendinopathy. Some reports have demonstrated that aspirin can induce apoptosis in cancer cells. However, evidence regarding aspirin treatment for tendinopathy, especially the effect of this treatment on tendon stem cells (TSCs), is lacking. Understanding the effect of aspirin on tendinopathy may provide a basis for the rational use of NSAIDs in clinical practice. The aim of our study was to determine whether aspirin induces apoptosis in rat TSCs via the Wnt/ß-catenin pathway. METHODS: First, we used flow cytometry and fluorescence to detect TSC apoptosis. Protein expression of the apoptosis-related caspase-3 pathway was investigated via western blot analysis. Next, we used western blotting to determine the effect of aspirin on the Wnt/ß-catenin pathway. We used immunostaining to detect the levels of Bcl2, cleaved caspase-3, and P-ß-catenin in the Achilles tendon. Finally, we used flow cytometry, fluorescence, and western blotting to investigate the aspirin-induced apoptosis of TSCs via the Wnt/ß-catenin pathway. RESULTS: Aspirin induced morphological apoptosis in rat TSCs via the mitochondrial/caspase-3 pathway and induced cellular apoptosis in the Achilles tendon. Apoptosis was partly reversed after adding the Wnt signaling activator Wnt3a and lithium chloride (LiCl, a GSK-3ß inhibitor). Aspirin administration led to a dose-dependent increase in COX-2 expression. Apoptosis was promoted after adding the COX-2 inhibitor NS398. CONCLUSION: The Wnt/ß-catenin pathway plays a vital role in aspirin-induced apoptosis by regulating mitochondrial/caspase-3 function. Elevating COX-2 levels may protect cells against apoptosis. More importantly, the results remind us to consider the apoptotic effect of aspirin on TSCs and tendon cells when aspirin is administered to treat tendinopathy. The relationship between the positive and negative effects of aspirin remains a subject for future study.

A Chip for Detecting Tuberculosis Drug Resistance Based on Polymerase Chain Reaction (PCR)-Magnetic Bead Molecule Platform.

Objective: A Tag Array chip was used to detect plasmids of different template concentration, and then analyzed for sensitivity and specificity. Drug resistance genes from tuberculosis clinical specimens were detected, giving comparative phenotypic resistance results to explore the feasibility and value of clinical applications. Methods: Twenty-four strains of Mycobacterium Tuberculosis (MTB) having sequence differences in extracted plasmids of mutant strains. The plasmid was diluted into different concentrations, and then was performed to analyze the sensitivity and specificity of the chip system. A total of 427 clinical specimens (including spinal tuberculosis and pulmonary tuberculosis) were collected from patients who came from seven hospitals. Design, optimization and preparation of the chip detection system, sequencing and phenotypic drug susceptibility results were analyzed to evaluate the sensitivity and specificity of the gene chip. Results: In the template, concentrations of 1 × 103 copies/µL and above were consistent with sequencing results in the mutant. The sensitivity and specificity in spine Tuberculosis specimen of rifampicin (RFP) were 94.40 and 92.86%; isoniazide (INH) were 92.37 and 87.50%; ethambutol (EMB) were 61.36 and 89.29%; fluoroquinolones (FQS) were 79.41 and 92.86%; streptomycin (SM) were 90.18 and 89.29%; second line drugs (SLD) were 77.61 and 83.93%. In Pulmonary Tuberculosis specimen, the sensitivity and specificity respectively were RFP: 92.74%; 93.75%; INH: 91.26%; 87.50%; EMB: 54.17%; 89.58%; FQS: 84.87%; 93.75%; SM: 86.73%; 85.42%; SLD: 80.9%; 91.67%. The RFP, INH, FQs and SM resistance genes was highly sensitive and specific: however, for detection of amikacin (AMK), capreomycin (CPM), kanamycin (KM), specificity was higher, but sensitivity was lower. Sensitivity for the detection of a mutation in the eis promoter region could be improved. Conclusion: Tag Array chip can achieve rapid, accurate detection of tuberculosis resistance, which has important clinical significance and feasibility.

Tag Array gene chip rapid diagnosis anti-tuberculosis drug resistance in pulmonary tuberculosis -a feasibility study.

OBJECTIVE: We developed a Tag Array chip for detecting first- and second-line anti tuberculosis drug resistance in pulmonary tuberculosis and compared the analytical performance of the gene chip to that of phenotypic drug susceptibility testing (DST). METHODS: From November 2011 to April 2016.234 consecutive culture-confirmed, clinically and imaging diagnosed patients with pulmonary tuberculosis from Southwest Hospital, Chongqing were enrolled into the study. Specimens collected during sputum or bronchoalveolar lavage fluid from the pulmonary tuberculosis patients were subjected to M. tuberculosis species identification and drug-resistance detection by the Tag Array gene chip, and evaluate the sensitivity and specificity of chip. RESULTS: A total of 186 patients was diagnosed drug-resistant tuberculosis. The detection of rifampicin (RFP), isoniazid (INH), fluoroquinolones (FQS), streptomycin (SM) resistance genes was highly sensitive and specific: however, for detection of amikacin (AMK), capreomycin (CPM), Kanamycin (KM), specificity was higher, but sensitivity was lower. Sensitivity for the detection of a mutation in the eis promoter region could be improved. The detection sensitivity of the EMB resistance gene was low, therefore it is easy to miss a diagnosis of EMB drug resistance, but its specificity was high. CONCLUSION: Tag Array chip can achieve rapid, accurate and high-throughput detection of tuberculosis resistance in pulmonary tuberculosis, which has important clinical significance and feasibility.

Surgical Treatment of Thoracic Spinal Tuberculosis: A Multicenter Retrospective Study.

OBJECTIVE: The aim of the present multicenter, retrospective study was to assess the safety and effectiveness of different surgery strategies for the treatment of thoracic tuberculosis and to provide a reference for surgical treatment of thoracic tuberculosis. MATERIALS AND METHODS: This study reviewed 394 patients with thoracic tuberculosis who were treated in 6 institutions between January 2000 and January 2015. There were 208 men and 186 women with an average age of 34.92 ± 13.14 years (range 5-76 years). A total of 73 patients underwent one-stage anterior surgery (group A); 84 underwent an anterior combined posterior surgery (group B); and 237 underwent one-stage posterior surgery (group C). Clinical outcome, laboratory indexes, and radiologic results were analyzed to observe the advantage of posterior approach surgery. RESULTS: All cases were followed up for about 26-60 months (average of 37 months). At the last follow-up, all patients reached bone fusion, pain relief, and neurologic recovery. There were significant differences before and after treatment in terms of the visual analog scale and Oswestry Disability Index scores (P < 0.05). Posterior approach significantly improved kyphosis (P < 0.05). CONCLUSIONS: Posterior fixation is superior to anterior fixation in the correction of kyphosis and maintenance of spinal stability. One-stage posterior surgery can achieve the same efficacy as anterior-only or combined surgery, with less trauma, less blood loss, and shorter operative times. However, for wide lesions or paraspinal abscesses, severe bone destruction, and anterior and middle column defects that are too large after debridement to require long segment bone grafting, the anterior combined posterior approach is indispensable.

Improvement in clinical outcome and infection control using molecular diagnostic techniques for early detection of MDR tuberculous spondylitis: a multicenter retrospective study.

There has been limited research on the therapeutic efficacy of molecular diagnosis of spinal tuberculosis. We attempted to determine whether the utilization of molecular diagnosis to detect multidrug-resistant spinal tuberculosis can improve clinical outcomes. A multicenter retrospective study was conducted from February 2009 to June 2015. Ninety-two consecutive culture-confirmed multidrug-resistant tuberculosis (MDR-TB) patients with spinal tuberculosis who were diagnosed clinically and by imaging were enrolled in the study. The initial time to treatment for MDR-TB, the method of infection control, the erythrocyte sedimentation rate (ESR) and the occurrence of complications in patients who were diagnosed using molecular methods were compared with those of patients diagnosed using standard culture and drug susceptibility test methods. Of 92 MDR-TB patients with spinal tuberculosis, 41 (45%) were diagnosed by standard culture and drug susceptibility test methods (Group A), and 51 (55%) were diagnosed following implementation of detection using molecular diagnosis (Group B). The patients in Group B began the rational use of second-line drugs earlier than patients in Group A (5 days vs 73 days, P<0.05). Among patients who were admitted to a general tuberculosis ward, those in Group B spent less time in the ward than those in Group A (4 days vs 33 days, P<0.05). At the one-month follow-up, the ESR was significantly lower in Group B. In patients who completed 6 months of follow-up (n=92), the incidence of complications was significantly lower in Group B. The use of molecular diagnosis resulted in noteworthy clinical advances, including earlier initiation of MDR-TB treatment, improved infection control, better clinical outcome, a more rapid decrease in ESR and fewer complications.

Effect of Tendon Stem Cells in Chitosan/ß-Glycerophosphate/Collagen Hydrogel on Achilles Tendon Healing in a Rat Model.

BACKGROUND The aim of this study was to determine whether the local application of tendon stem cells (TSCs) with chitosan/ß-glycerophosphate/collagen(C/GP/Co) hydrogel promotes healing after an acute Achilles tendon injury in a rat model. MATERIAL AND METHODS Ninety-six Sprague-Dawley (SD) rats were used to make an Achilles tendon defect model, then the animals were randomly divided into 4 groups consisting of 8 rats each: control group, hydrogel group, TSCs group, and TSCs with hydrogel group. At 2, 4, and 6 weeks after treatment, tendon samples were harvested, and the quality of tendon repair was evaluated based on histology, immunohistochemistry, and biomechanical properties. RESULTS Combining TSCs with C/GP/Co hydrogel significantly enhances tendon healing compared with the control, hydrogel, and TSCs groups. The improved healing was indicated by the improvement in histological and immunohistochemistry outcomes and the increase in the biomechanical properties of the regenerated tissue at both 4 and 6 weeks post-injury. CONCLUSIONS This study demonstrates that the transplantation of TSCs combined with C/GP/Co hydrogel significantly improved the histological, immunohistochemistry, and biomechanical outcomes of the regenerated tissue at 4 and 6 weeks after implantation. TSCs with C/GP/Co hydrogel is a potentially effective treatment for tendon injury.

Large hemorrhage due to venipuncture in the elbow of a patient with severe hemophilia: A case report and literature review.

Hemophilia A, which is the most common form of hemophilia, is caused by a deficiency of clotting factor VIII. The incidence of hemophilia A is 1:10,000 people worldwide. The most common complication associated with hemophilia A is bleeding into joints, predominantly the knees, ankles, and elbows, which may lead to destruction or osteoarthritis of the specific joint. Various degrees of disability may follow these initial or recurrent hemorrhages. Subsequent to improvements in medical management, patients with hemophilia A currently have a life expectancy similar to that of the normal population. However, the management of patients with hemophilia A remains a clinical challenge for various reasons, including the lack of reliable and cost-effective treatment, and the high risk of intra- or post-operative hemorrhages. Large hemorrhages due to the phlebotomizing of young patients are very rare. To the best of our knowledge, the present case is the first report regarding the occurrence of a large hemorrhage due to venipuncture in the elbow of a patient with hemophilia A, and discusses the pathogenesis, clinical manifestation, and the medico-chirurgical treatment of this patient.

Wear assessments of a new cervical spinal disk prosthesis: Influence of loading and kinematic patterns during in vitro wear simulation.

Surgical treatment is one of the effective methods of treatment in cervical spondylosis. The traditional method of operation is decompression fusion; however, this surgery results in restricted movement of cervical vertebra and adjacent segment degeneration. Due to the deficiency of traditional surgery, scholars have widely carried out artificial cervical disk replacement surgery and have achieved good clinical effects. Comparing to the characteristics of the common artificial cervical disk which is used frequently, we developed a new artificial cervical intervertebral disk prosthesis. The purpose of this study was to determine the wear behavior in a cervical total disk replacement system. The total disk replacement system tested consists of a ultra-high-molecular-weight polyethylene inlay articulating between a Ti6Al4V alloy superior plate and an inferior plate, using a spine wear simulator, per the ISO 18192-1:2011 standard test methods. Three rotations and axial force were applied on each station. The specimens were removed at 5 × 10(5) and 10(6) cycles and at intervals of 10(6) cycles thereafter to determine the actual mass loss. The serum was replaced every 5 × 10(5) cycles. The specimens were changed periodically among the different stations. A mean ultrahigh molecular weight polyethylene inlay wear rate of 0.53 mg per million cycles (standard = 0.13 mg per 10(6) cycles) was found after 10(7) cycles. All inferior plates showed slight scratching after 10(7) cycles. The impingement wear simulation introduced here proved to be suitable to predict in vivo impingement behavior in regard to the contact pattern seen on retrieved devices of the Pretic-I disk arthroplasty design in a preclinical test.

The Effects of Forearm Support on Upper Body for People in Front of Monitor: A Meta-Analysis.

With the ever-growing number of people who work at visual display terminals, the work-related musculoskeletal disorders of the upper body are believed to be an important problem all over the world. The forearm support, which can keep the forearm and wrist in biomechanical posture, is a possible protective factor of the development of upper body syndrome. This meta-analysis examines the efficacy of forearm support in reducing upper body syndrome. The Cochrane Library, EMBASE, Ovid, ScienceDirect, SpringerLink, Google Scholar, CNKI database, and Wanfang database were searched from inception until May 29, 2013. Relevant studies were included after the screening of title, abstract, and the full text. Impact of bias was assessed independently by 2 authors. Four studies that met all the inclusion criteria were included finally. The combined results based on all studies suggested that statistically the forearm support had a nonsignificant effect on upper body syndrome (odds ratio [OR] = 0.70, 95% confidence interval [CI]: 0.49, 1.02). The result of subgroup analysis suggested that forearm support has a significant effect on neck or shoulder syndrome (OR = 0.70, 95% CI: 0.43, 1.14) and the effect on upper extremity syndrome (OR = 0.76, 95% CI: 0.49, 1.19) is not significant. This meta-analysis suggested that the forearm support had statistically nonsignificant effect on preventing upper body syndrome on the whole.