Achilles tendon thickening does not affect elasticity and functional outcome after surgical repair of Achilles rupture: A retrospective study.

PURPOSE: Previous studies have confirmed that Achilles tendon occurs Achilles thickening after repair surgery of the rupture. Although this mechanism has been elucidated in the laboratory, there are few reports on its impact on clinical function. We designed a retrospective study to investigate the Achilles thickening after Achilles tendon rupture repair and its correlation between the elasticity and postoperative function. METHODS: In this retrospective analysis, patients who underwent surgical treatment for acute Achilles tendon rupture from April 2016 to April 2020 were included. All the patients were regularly followed up at 3 months, 1 year, and 2 years after surgery. American Orthopaedic Foot Ankle Surgeon (AOFAS) scale and Leppilahti score were used to evaluate functional outcomes. Achilles elasticity was measured by ultrasound shear wave of elasticity. Achilles thickening was calculated as maximal transverse and longitudinal diameter in cross-sectional plane of magnetic resonance scan. Sample t-tests was used for different follow-up periods. Correlation between Achilles thickening and other factors were analyzed using Pearson's method. p < 0.05 indicates a statistically significant difference. RESULTS: AOFAS scale and Leppilahti score at 1 year were significantly higher than at 3 months postoperatively (both p < 0.001). These functional scales were also improved at 2-year follow-up significantly (both p < 0.001). The dorsiflexion difference showed gradually recovery in each follow-up period (t = -17.907, p < 0.001). The elasticity of the Achilles appeared to continuously decreases during the postoperative follow-up period in all position sets (p < 0.001). In thickening evaluation, the cross-sectional area of the thickest plane of Achilles was significantly higher at 1 year postoperatively (310.5 ± 25.2) mm2 than that at 3 months postoperatively ((278.0 ± 26.2) mm2, t = -8.219, p < 0.001) and became thinner in 2-year magnetic resonance scan ((256.1 ± 15.1) mm2, t = 16.769, p < 0.001). The correlations between Achilles thickening, elasticity, and functional outcome did not show statistical significance (p > 0.05) in every follow-up period. CONCLUSION: Achilles tendon thickens after surgery in the 1st year, but begins to gradually return to thinning about 2 years after surgery. There was no significant correlation between the increase and decrease of thickening and the patients' clinical function scores, Achilles elasticity, and bilateral ankle dorsiflexion difference.

Irisin alleviates hyperoxia-induced bronchopulmonary dysplasia through activation of Nrf2/HO-1 pathway.

BACKGROUND: Bronchopulmonary dysplasia (BPD) is a common pulmonary injury among premature infants, which is often caused by hyperoxia exposure. Irisin is a novel hormone-like myokine derived mainly from skeletal muscles as well as adipose tissues. Many studies have indicated that Irisin exert a variety of properties against hyperoxia-induced inflammation and oxidative stress (OS). We aimed to evaluate the effects of irisin on hyperoxia-induced lung injury explore the underlying mechanisms. METHODS: BPD model was established after exposing newborn mouse to 85% oxygen. BPD mouse received continuous intraperitoneal injection of irisin at a dose of 25 µg/kg/day. Lung tissues were collected for histological examination at 7 and 14 days after birth. The alveolarization and alveolar vascularization of each animal was assessed. Levels of oxidative stress indicators, and the expression of nuclear factor erythroid 2-related factor 2 (Nrf2) and heme oxygenase-1 (HO-1) in lung tissues were detected at 14 days after birth. RESULTS: Hyperoxia exposure induced a markedly alveolar simplification and a disrupted alveolar angiogenesis, which was ameliorated by irisin treatment. The hyperoxia-induced increase in these oxidative stress indicators was significantly reversed by irisin treatment. The Nrf2/HO-1 pathway is inducted in the hyperoxia-induced BPD mouse model, which is further activated by irisin treatment. CONCLUSION: Our results demonstrated the beneficial effects of irisin in reducing the OS, enhancing alveolarization, and promoting vascular development through activation of Nrf2/HO-1 axis in a hyperoxia-induced experimental model of BPD.

[Osteopractic total flavone promoting rat extra-articular tendon-bone healing through mTOR pathway].

OBJECTIVE: To explore function and related molecular mechanism of osteopractic total flavone (OTF) on tendon healing in rats. METHODS: Ten male rats aged for 8 weeks were collected and weighted from 180 to 220 g. Tendon stem cells were cultivated, the third tendon stem cells were used for experiment. OTP treated with 0, 0.1, 1, 10 ng/ml were added into tendon stem cells, and expression change of ALP, Runx2, OCN, VEGF, P-S6, P-4E/BP1 were detected after 14 days. Forty male rats aged for 8 weeks (weighted 180 to 220 g) were established extra-articular tendon-bone transplanting healing model, and divided into experimental group and control group. Experimental group were treated with OTF(100 mg·kg⁻¹·d⁻¹), while control group was treated by normal saline with the same volume. Tendon-bone healing degree were detected by biomechanical testing at 3 and 6 weeks after surgery, histological detection were applied to detect tendon-bone healing and number of new vessles. RESULTS: After treated by OTP, ALP staining and active index detection showed there were statistical differences among 0, 0.1, 1, 10 ng/ml group. After 14 days' cultivation, western blotting results showed mTOR downstream marker protein P-S6 protein expression were gradually increased with increase of density of OTP, expression of P-4E/BP1 was reduced, while expression of Runx2, OCN, VEGF were increased. Biological detection results showed that there was no significant difference in mechanical strength between experimental group(0.78±0.05) N/mm and control group (0.51±0.02) N/mm at 3 weeks after surgery, while mechanical strength in experimental group (1.36±0.09) N/mm was higher than control group (1.01±0.08) N/mm at 6 weeks after surgery. Histological results showed maturity of tendon-bone surface cell were higher at 3 and 6 weeks in experimental group, sharpey fiber growth more density, calcification extent of mesenchyme was high, and new bone, vessels were increased. CONCLUSIONS: OTF could promote osteogenic differentiation of tendon stem cells through mTOR signaling in vitro, and stimulate tendon-bone healing in bone tunnel and enhance connection quality between tendon and bone.

Bergapten promotes bone marrow stromal cell differentiation into osteoblasts in vitro and in vivo.

Many recent studies have suggested that bergapten (BP), a class of native compound with numerous biological activities such as anti-resorptive properties, may exert protective effects against postmenopausal bone loss. However, it remains unknown whether BP regulates or improves the osteogenic function of bone marrow stromal cells (BMSCs) in the treatment and prevention of osteoporosis. In our study, BMSCs were cultured in osteogenic induction medium with the addition of BP for 2 weeks and an ovariectomized mouse model of osteoporosis was used to investigate the anti-resorptive effect of BP by gavage administration for 3 months. The concentrations of BP used were 0.1, 1, and 10 µmol/L in vitro and the gavage dose was 20 mg/kg/d. The result of our study indicated that BP promotes the expression of alkaline phosphatase (ALP) by BMSCs in vitro in a dose-dependent manner, as revealed by ALP staining. Runt-related transcription factor 2 and osteocalcin were up-regulated both in vitro and vivo, while osterix and collagen Iα1, assessed by immunofluorescence and immunohistochemistry, were correspondingly raised in the presence of BP in BMSCs in vitro. In addition, a protective effect of BP against ovariectomy-induced bone loss was found by distal femur micro-CT scanning, with improvements of bone metabolism parameters such as bone mineral density, trabecular number, and trabecular separation. Furthermore, WNT/ß-catenin signaling was activated in the presence of BP in BMSCs in osteogenic culture. Finally, BP promoted differentiation of BMSCs into osteoblasts by up-regulation of the WNT/ß-catenin pathway.

Congenital heart disease in adolescents with gluteal muscle contracture.

Gluteal muscle contracture (GMC), presented with hip abduction and external rotation when crouching, is common in several ethnicities, particularly in Chinese. It remains unclear that the reasons why these children are weak and have no choice to accept repeated intramuscular injection. Here, we found some unique cases which may be useful to explain this question. We describe a series of special GMC patients, who are accompanied with congenital heart disease (CHD). These cases were first observed in preoperative examinations of a patient with atrial septal defect (ASD), which was proved by chest X-ray and cardiac ultrasound. From then on, we gradually identified additional 3 GMC patients with CHD. The original patient with ASD was sent to cardiosurgery department to repair atrial septal first and received arthroscopic surgery later. While the other 3 were cured postoperative of ventricular septal defect (VSD), tetralogy of fallot (TOF), patent ductus arteriosus (PDA), respectively, and had surgery directly. The study gives us 3 proposals: (1) as to CHD children, it is essential to decrease the use of intramuscular injection, (2) paying more attention to cardiac examination especially cardiac ultrasound in perioperative period, and (3) taking 3D-CT to reconstruct gluteal muscles for observing contracture bands clearly in preoperation. However, more larger series of patients are called for to confirm these findings.

Co-expression of CXCR4 and CD133 proteins is associated with poor prognosis in stage II-III colon cancer patients.

Although CXCR4 and CD133 have been implicated in the metastatic process of malignant tumors, the clinicopathological significance of their expression in human colon cancer is not fully understood. The present study aimed to examine the expression of the CXCR4 and CD133 proteins in cases of stage II or III colon cancer and the related lymph nodes and to investigate the clinical and prognostic significance of these proteins in colon cancer. Immunohistochemical analysis was performed to examine CXCR4 and CD133 protein expression in paraffin-embedded stage II or III primary colon cancer tissues and matched lymph nodes. The correlation between the expression of the two proteins and clinicopathological parameters and the patient 5-year survival was analyzed. CXCR4 expression was detected in 74 of the 125 tumors (59.2%) and CD133 expression was detected in 45 (36.0%). The co-expression of CXCR4 and CD133 (both CXCR4 and CD133 were positive) was detected in 29 of the 125 tumors (23.2%). Compared with the other combinations, the co-expression of the CXCR4 and CD133 proteins was significantly associated with American Joint Committee on Cancer (AJCC) stage (P=0.029) and lymph node status (P=0.020). Log-rank analysis revealed that AJCC stage (P=0.014), lymph node status (P=0.011), CXCR4 expression (P=0.023), CD133 expression (P=0.034) and the co-expression of the CXCR4 and CD133 proteins (P=0.003) were significant prognostic indicators for the overall survival of patients. The results of the present study show that the co-expression of the CXCR4 and CD133 proteins is a risk factor for poor overall survival in stage II or III colon cancer patients, indicating that the co-expression of the CXCR4 and CD133 proteins contributes to the progression of colon cancer.

[Clinical features of pathologically confirmed metastatic bone tumors--a report of 390 cases].

BACKGROUND & OBJECTIVE: With the development of diagnostic techniques of imaging and pathology, early diagnosis of metastatic bone tumors has been greatly improved, but the clinical characteristics which are essential for diagnosis are rarely reported. In this article, the clinical features of pathologically confirmed metastatic bone tumors were analyzed for further improvement of early diagnosis and treatment. METHODS: Clinical data of 390 patients with pathologically confirmed metastatic bone tumors, treated from 1980 to 2003 at The First Affiliated Hospital of Sun Yat-sen University, were reviewed respectively to summarize the clinical features, including disease history, predilection sites, clinical manifestation, and imaging presentations. RESULTS: Of the 390 patients, the ratio of men to women was 2.12:1; the median age was 55.7 years, and 81.5% of the patients were over 41 years old. The primary tumors were lung cancer (21.8%), prostate cancer (13.1%), breast cancer (7.4%), liver cancer (6.4%), gastrointestinal cancer (5.7%), and unknown cancers (24.6%). The common metastatic sites were spine (47.7%), pelvis (18.2%), femur (15.4%), and rib (12.6%). Multiple metastases occurred in 20.5% of the patients. The main symptoms were skeletal pain (53.3%), pathologic fractures (10.3%), dysfunction (4.9%), and paraplegia (2.1%). Primary tumor detected before metastasis accounted for 29.7% of the patients with a median metastatic time of 319 days, and the metastatic intervals were uncertain in 70.3% of the patients. Osteolytic types accounted for 80.7% of the cases in radiographic patterns, followed by osteosclerotic (10.5%) and mixed types. CONCLUSIONS: Metastatic bone tumors most frequently occur in patients older than 41 years, and commonly originate from lung, prostate, breast, and liver. Vertebrae, pelvis, femur, and rib are the most common sites of metastases. The clinical manifestation is extensive and nonspecific. Most lesions present osteolytic patterns. Metastases with unknown origin account for 24%. In spite of complexity, the clinical features should be mastered for early diagnosis and treatment.