Effect of Taohong Siwu Decoction() early intervention on mesenchymal stem cells homing in fracture healing in rats / 中国骨伤

OBJECTIVE@#To observe the effects of Taohong Siwu Decoction(, THSWD) on the mesenchymal stem cells(MSCs) migration, homing number and cytokine expression in callus during the early process of fracture healing, and to explore the mechanism of THSWD on accelerationg fracture healing by regulating the homing of MSCs in rats.@*METHODS@#A rat model of right femoral shaft open fracture was established. Thirty-two 5-week-old male Sprague-Dawley rats, weighting 110 to 130 g, were divided into control group, low-dose group, medium-dose group and high-dose group by using random number table. Distilled water was given to the control group, and the other groups were given Taohong Siwu Decoction. The rats were gavaged twice a day for 5 consecutive days after surgery. Bone volume/tissue volume(BV/TV) and bone mineral density(BMD) were observed using micro-computed tomography (micro-CT) at 21 days after surgery. At 5 days post-fracture, peripheral blood MSCs from THSWD treated and untreated rats were cultured in vitro. Subsequently, the migration ability of MSCs was observed by cell migration assay. The number of MSCs homing to the callus at the early stage of fracture (5 d) was detected by Immunohistochemistry (IHC). Protein chip was used to detect the expression of cytokines in callus.@*RESULTS@#Micro-CT results showed that BV/TV was higher in the high-dose group than in the medium-dose group (P=0.032), and higher in the medium-dose group than in the low-dose group(P=0.041), with no difference between the control and low-dose group (P=0.651). In addition, there was no difference in BMD between low-dose group and the model group (P=0.671), and lower in the low-dose group than in the medium-dose group(P=0.018), and the medium-dose group was lower than the high-dose group(P=0.008). Cell migration assay showed that THSWD promotes enhanced the migration ability of peripheral blood MSCs. IHC assay revealed that CD45-, CD90+, CD29+ MSCs significantly increased in bone callus after THSWD intervention compared with the control group. Protein chip showed that THSWD promoted the upregulation of CINC-1(×2.91), CINC-3(×1.59), LIX(×1.5), Thymus Chemokine (×2.55), VEGF (×1.22) and the down-regulation of TIMP-1 (×2.98).@*CONCLUSION@#THSWD, a representative formula of "promoting blood circulation and removing blood stasis", can significantly accelerate fracture healing, and its mechanism may be related to enhancing the migration ability of peripheral blood MSCs and up-regulating CINC-1, CINC-3, LIX, Thymus Chemokine, VEGF and down-regulating TIMP-1 in bone callus, which promotes the peripheral blood MSCs homing in the early stage of fracture.

Microscopic morphology observation of fracture healing process promoted by panax notoginseng saponins / Observación microscópica de la morfología del proceso de curación de fracturas promovida por panax notoginseng saponins

SUMMARY: The aim of this study was to explore promoting effect of external applying Panax Notoginseng Saponins (PNS) on fractures. For this analysis 18 New Zealand male rabbits were divided into control group, splintage group and PNS group. All rabbits were performed left radius fractures and natural healing, splintage healing and splintage coated with PNS healing. 2 rabbits in each group were sacrificed on day 14, day 28 and day 42 after surgery, separately. Atomic force microscope scanning and nanoindentation tests were performed on the callus sections. The particle size and roughness in PNS group was both less than that in splintage group. The elastic modulus of callus in PNS group was consistent with normal bone tissue started from day 28 after surgery, two weeks earlier than that in splintage group. PNS could significantly reduce fracture healing time and increase strength of callus.

RESUMEN: El objetivo de este estudio fue evaluar el efecto de la aplicación externa de Panax Notoginseng Saponins (PNS) en fracturas óseas. Se usaron 18 conejos machos de raza Nueva Zelanda divididos en grupos control, entablillado y PNS. Se realizaron fracturas del radio izquierdo y cicatrización natural en todos los animales, además de la cicatrización con entablillado y entablillado recubierto con PNS. Se sacrificaron, posterior a la cirugía, dos conejos de cada grupo los día 14, 28 y 42. Se realizaron pruebas de escaneo con microscopio de fuerza atómica y nanoindentación en las secciones de callos. El tamaño de la partícula y la rugosidad en el grupo de PNS fue menor que en el grupo entablillado. El módulo elástico del callo en el grupo de PNS fue consistente con el tejido óseo normal iniciado el día 28 después de la cirugía, dos semanas antes que en el grupo de entablillado. El PNS podría redu- cir significativamente el tiempo de curación de la fractura y aumentar la fuerza del callo.

Alendronato administrado en el foco de fractura: Estudio experimental en conejos / Alendronate administered at the fracture site. Experimental study in rabbits

Introducción: El objetivo de este estudio experimental fue evaluar el resultado radiológico e histológico del empleo de alendronato colocado localmente en el foco de fracturas de fémur en conejos. Materiales y Métodos: Se utilizaron 30 conejos a los cuales se les fracturó el fémur derecho y se los dividió en tres grupos de 10 animales cada uno. A los conejos del grupo 1 se les colocó una solución con alendronato en el foco de fractura; los del grupo 2 fueron sometidos al mismo procedimiento a los siete días de la fractura y el grupo 3 era de control. Se realizó la evaluación radiográfica en el momento de la fractura y a los 42 días del procedimiento. Se evaluaron las características del callo óseo mediante anatomía patológica, radiología y tomografía computarizada. Resultados: Se evaluaron 24 conejos (2 conejos del grupo 2 y 4 del grupo 3 murieron). El análisis histológico reveló moderada formación ósea en los tres grupos, sin diferencias estadísticamente significativas (p = 0,8336). Según los resultados de los estudios por imágenes, no existieron diferencias estadísticamente significativas en el tamaño del callo óseo entre los grupos para los dos estudios (radiografía: p = 0,777 y tomografía: p = 0,349). Conclusión: El alendronato colocado localmente en el foco de fractura, en la etapa aguda y luego de una semana, no alteró, de manera estadísticamente significativa, el proceso normal de consolidación, determinado por anatomía patológica y radiología, a las seis semanas de la fractura de fémur en conejos. Nivel de Evidencia: II

Introduction: The aim of this experimental study was to evaluate the radiologic and histological results of the use of alendronate administered locally at the fractures site in rabbits. Methods: The fractured right femur of 30 rabbits was used for evaluation. The animals were distributed in three groups of 10 rabbits each. A solution with alendronate was placed at the fracture site in group 1; the same procedure was performed 7 days after the fracture in group 2, and group 3 functioned as control. Radiographic evaluation was performed at the time of the fracture and at day 42. Radiological, PA and CT-scan evaluations of bone callus characteristics in each rabbit were performed. Results: Twenty-four rabbits were evaluated (2 rabbits in group 2 and 4 in group 3 died). Histological evaluation evidenced moderate bone formation in the three groups without statistically significant differences (p=0.8336). Concerning imaging studies, there were no statistically significant differences in the size of bone callus among groups for both studies (X-rays: p=0.777 and CT: p=0.349). Conclusion: The use of alendronate administered locally at the fracture site, in the acute period and after one week, did not alter the normal consolidation process determined by PA and radiology, six weeks after femur fracture in rabbits. Level of Evidence: II

Effects of local alendronate administration on bone defect healing. Histomorphometric and radiological evaluation in a rabbit model

Abstract Purpose: To performed a histomorphometric and radiological study to evaluate the effects of alendronate sodium administered locally in mandibular bone defects created in rabbits. Methods: Two circular defects 5 mm in diameter were created bilaterally in the mandibular corpus of 20 New Zealand rabbits (i.e., four defects per animal). Each defect received one of four treatments: no treatment (EC group), alendronate irrigation (AL group), autogenous bone grafting (AG group), or alendronate irrigation with autogenous bone grafting (AL+AG group). Histomorphometric and radiological assessments were conducted at 4 and 8 weeks after surgery. Results: Between-group comparisons of the new bone area, the value of the AL+AG group was significantly lower thanthe remaining three groups at 4 weeks postoperatively. In all groups, the new bone area was significantly larger at 8 weeks than at 4 weeks. The residual graft area at 4 and 8 weeks was significantly higher in the AL+AG group than in the AG group, although it was significantly smaller at 8 weeks than at 4 weeks in both these groups. Conclusion: The use of alendronate sodium in conjunction with autogenous bone grafting improves the osteoconductive properties of the graft, enhances graft retention in the defect, and improves ossification.

Acurácia na inferência de diagnósticos de enfermagem de pacientes com insuficiência cardíaca / La precisión en inferencia de diagnóstico de enfermería en pacientes con insuficiencia cardíaca / Accuracy in inference of nursing diagnoses in heart failure patients

RESUMOInsuficiência cardíaca (IC) é causa frequente de internação exigindo do enfermeiro precisão na conduta clínica e adequado julgamento dos diagnósticos de enfermagem.Objetivo:verificar acurácia na determinação dos diagnósticos de enfermagem fadiga, intolerância à atividade e débito cardíaco diminuído em paciente com IC hospitalizados.Método:estudo descritivo aplicado aos enfermeiros experientes em diagnósticos de enfermagem NANDA-I e/ou IC. Avaliação da acurácia foi realizada a partir do cálculo das medidas: eficácia (E), falso negativo (FN), falso positivo (FP) e tendência (T). Foram aptos os enfermeiros com inspeção aceitável para dois diagnósticos.Resultados:o diagnóstico de enfermagem fadiga foi o mais erroneamente identificado pelos enfermeiros avaliadores.Discussão:a busca pelo aperfeiçoamento da acurácia diagnóstica reafirma a necessidade de treinamento contínuo e específico para a melhora da capacidade diagnosticadora do enfermeiro.Conclusão:o treinamento permitiu o exercício do raciocínio clínico e melhor acurácia dos enfermeiros.

RESUMENInsuficiencia cardíaca (IC) es causa frecuente de ingresos hospitalarios exigindo del enfermero precisión en la conducta clínica y adecuado juzgamiento de los diagnósticos de enfermería.Objetivo:verificar la precisión en la determinación de los diagnósticos de enfermería fatiga, disminuición del gasto cardíaco e intolerancia a la actividad en pacientes con IC ingresos en hospitales.Método:estudio observacional, con enfermeros docentes y experientes en diagnósticos de enfermería NANDA-I y/o IC. Evaluación y precisión fueron realizadas por através del cálculo: eficacia (E), falso negativo (FN), falso positivo (FP) y tendecia (T). Fueron aptos los enfermeros con inspección aceptable para dos diagnósticos.Resultados:el diagnóstico de enfermería fatiga fue identificado erróneamente como por evaluadores enfermeras.Discusión:la búsqueda de la mejora de la precisión diagnóstica reafirma la necesidad de una formación continua y específica a la mejora de la capacidad del diagnosticador enfermera.Conclusión:la capacitación permitió el ejercicio del raciocínio y mejor precisión de los enfermeros.

ABSTRACTHeart failure (HF) is a common cause of hospitalization and requires accuracy in clinical judgment and appropriate nursing diagnoses.Objective:to determine the accuracy of nursing diagnoses of fatigue, intolerance to activity and decreased cardiac output in hospitalized HF patients.Method:descriptive study applied to nurses with experience in NANDA-I and/or HF nursing diagnoses. Evaluation and accuracy were determined by calculating effi cacy (E), false negative (FN), false positive (FP) and trend (T) measures. Nurses who showed acceptable inspection for two diagnoses were selected.Results:the nursing diagnosis of fatigue was the most commonly mistaken diagnosis identifi ed by the nursing evaluators.Discussion:the search for improving diagnostic accuracy reaffi rms the need for continuous and specifi c training to improve the diagnosis capability of nurses.Conclusion:the training allowed the exercise of clinical judgment and better accuracy of nurses.

Living Donor Liver Transplantation for an Infant with Osteogenesis Imperfecta and Intrahepatic Cholestasis: Report of a Case

Osteogenesis imperfecta (OI) is a group of genetic disorders characterized by bone fragility and connective tissue manifestations. We report a successful liver transplantation (LT) in an 8-month-old boy with OI and cholestatic biliary cirrhosis. After 4 cycles of intravenous pamidronate, LT was performed under intravenous anesthesia using a left lateral section from his mother without mechanical retractors. The operation time was 420 min and estimated blood loss was 520 mL requiring one unit of RBC transfusion. He was discharged without surgical complications. Therefore, LT should be considered for patients with end stage liver disease and OI under organic multidisciplinary cooperation.

The effects of alpha-tocopherol supplementation on fracture healing in a postmenopausal osteoporotic rat model

OBJECTIVE: Osteoporosis increases the risk of bone fractures and may impair fracture healing. The aim of this study was to investigate whether alpha-tocopherol can improve the late-phase fracture healing of osteoporotic bones in ovariectomized rats. METHOD: In total, 24 female Sprague-Dawley rats were divided into three groups. The first group was sham-operated, and the other two groups were ovariectomized. After two months, the right femora of the rats were fractured under anesthesia and internally repaired with K-wires. The sham-operated and ovariectomized control rat groups were administered olive oil (a vehicle), whereas 60 mg/kg of alpha-tocopherol was administered via oral gavage to the alpha-tocopherol group for six days per week over the course of 8 weeks. The rats were sacrificed, and the femora were dissected out. Computed tomography scans and X-rays were performed to assess fracture healing and callus staging, followed by the assessment of callus strengths through the biomechanical testing of the bones. RESULTS: Significantly higher callus volume and callus staging were observed in the ovariectomized control group compared with the sham-operated and alpha-tocopherol groups. The ovariectomized control group also had significantly lower fracture healing scores than the sham-operated group. There were no differences between the alpha-tocopherol and sham-operated groups with respect to the above parameters. The healed femora of the ovariectomized control group demonstrated significantly lower load and strain parameters than the healed femora of the sham-operated group. Alpha-tocopherol supplementation was not able to restore these biomechanical properties. CONCLUSION: Alpha-tocopherol supplementation appeared to promote bone fracture healing in osteoporotic rats but failed to restore the strength of the fractured bone.

Osteogenesis imperfecta.

Background: Osteogenesis imperfecta (OI) is a rare metabolic bone disorder characterized by increased bone fragility, low bone mass, recurrent fractures and numerous extra-osseus features. Many patients remain undiagnosed and unattended particularly in developed countries. Presently, medical management with bisphosphonates has changed the scenario. Materials and Methods: Twenty consecutive patients of OI were enrolled over a period of four years. Their clinical features, radiology, and biochemical parameters and treatment outcome were analysed. Results: Of the 20 patients, 16 (80%) were male and 4 (20%) were female. Mean age (SD) of the patients was 20.8 (13.8) years. All the patients had presented with fractures, the number of fractures per person varying from 1 to 20. Long bones were predominantly involved and thirteen (65%) had deformities of long bones. Ten (50%) had a positive family history of fractures after trivial traum. Eleven (55%) patients had dentiginous imperfecta (DI) and ten (50%) had blue sclerae at presentation. Impaired hearing was present in 1 patient only. Calcium profile was normal. Nine patients received pamidronate. Fracture frequency and pain decreased remarkably in these patients. Conclusion: Patients with OI presented late, predominantly with fracture of long bones, deformities and blue sclerae. Pamidronate therapy remarkably decreased fractures and pain in these patients. ©

effects of zinc supplementation on serum zinc, alkaline phosphatase activity and fracture healing of bones

To determine the effect of zinc supplementation on callus formation, serum zinc and alkaline phosphatase activity in humans. This randomized, double-blind, placebo controlled clinical trial was conducted on 60 patients with traumatic bone fracture referred to Shohada Hospital of Tabriz, Iran from August to December 2007. Subjects were randomly divided into 2 groups: cases [n=30], receiving one capsule of zinc sulfate consists of 50 mg zinc each day and the controls [n=30], receiving placebo for 60 days. Individual and clinical information was determined by a questionnaire: nutritional intake by 3 days food records at the beginning and the end of trial. Serum zinc and alkaline phosphatase was measured by atomic absorption spectroscopy, and by enzymatic method. Callus formation during fracture healing was evaluated by radiography of the bone. There was no significant difference in physical activity, gender, age, type of fractures, and nutrient intake, between the 2 groups. The administration of zinc caused a significant elevation of serum zinc and alkaline phosphatase activity. Assessment of bone x- rays showed a significant progress in callus formation in cases compared to the controls. This study shows that zinc supplementation can stimulate fracture healing, however, it needs further study

Effect of simvastatin on fracture healing--an experimental study.

Left femur was osteotomized and fixed with K wire in 21 rabbits. One group was fed simvastatin (120 mg/kg body wt/day) orally, whereas another group without medication served as control. Both groups were assessed radiologically, morphologically, histologically and biomechanically at 4, 8 and 12 weeks. An analysis of various parameters of study showed that simvastatin treated group had improved bone healing at 4 and 8 weeks of follow up, however, the difference was not significant statistically at 12 weeks. So it is concluded that Simvastatin favourably hastened the process of fracture healing in the rabbits at earlier phases.

Fracturas expuestas: Una urgencia en ortopedia. Revisión bibliográfica / Open fracture: A orthopedics emergency. Review bibliography

Se defiene como expuesta a una fractura cuando se encuentra en comunicación directa con el medio ambiente a través de una herida en la piel y los tejidos blandos circundantes, suelen presentarse más frecuentemente en hombres entre los 30 y 40 años de vida. Su diangóstico es básicamente semiológico y su tratamiento prehospitalario consiste en el comuplimiento de cuatro objetivos básicos tomando en cuenta la clasificiación y si el paciente es o no un politraumatizado. La oportuna y correcta estabilización de esa emergencia ortopédica puede librar al paciente de complicaciones y secuelas fácilmente evitables y reducir los costos institucionales significativamente.

Estudo randomizado do nimesulide, aceclofenaco e diclofenaco no tratamento de afecçöes traumáticas do aparelho locomotor / Randomized study nimesulide, aceclofenac and diclofenac in the treatment of traumatic injuries of the locomotor system

Diante dos novos conceitos resultantes da descoberta da existência de dois subtipos de ciclooxigenase (COX), COX-1 (constitutiva) e COX-2 (indutiva), o objetivo deste estudo foi avaliar a eficácia e tolerabilidade, no tratamento de afecçoes traumáticas do aparelho locomotor, de três antiinflamatórios nao hormonais (AINHs): nimesulide, o primeiro AINH inibidor seletivo da COX-2 disponível, e dois agentes clássicos nao seletivos, diclofenaco e aceclofenaco. Em três visitas clínicas e após sete dias de tratamento em que randomicamente 19 pacientes receberam nimesulide 100mg 2x/dia, 19 receberam aceclofenaco 100mg 2x/dia e 21 receberam diclofenaco 50mg 3x/dia, a eficácia foi avaliada clinicamente segundo a intensidade dos sinais e sintomas e pela avaliaçao global do pesquisador ao final do estudo, e a tolerabilidade pela ocorrência ou nao de eventos adversos bem como pela avaliaçao global ao término do estudo. Quanto à eficácia, o resultado obtido pelo grupo tratado com nimesulide foi significativamente melhor considerando-se os parâmetros dor à movimentaçao, limitaçao de movimentos, sensibilidade local e intensidade da dor. Também quanto à tolerabilidade, tanto o índice de ocorrência de reaçoes adversas como a avaliaçao final global foram significativamente melhores para o grupo nimesulide. Confirmando estudos anteriores, a seletividade de nimesulide sobre a COX-2 contribui para sua eficácia, assim como reflete seu perfil de segurança, ao contrário do aceclofenaco e diclofenaco, que nao têm esse grau de seletividade sobre a COX-2. Portanto, nimesulide pode ser considerado um antiinflamatório e analgésico de primeira escolha no tratamento de afecçoes traumáticas do aparelho locomotor.

Politraumatizado y fractura de pelvis / Polytraumatized and pelvic fracture

Pelvic trauma, its classification, clinical evaluation, CAT scan findings, complications and treatment is presented

Avaliaçåo clínica dos resultados terapêuticos do uso de nimesulide em condiçöes flogísticas do aparelho osteoarticular / Clinical efficacy of nimesulide in orthopedics and traumatology

Foram avaliados 30 pacientes com patologias inflamatórias agudas nåo infecciosas do aparelho locomotor. Houve melhora total ou parcial de todas as principais manifestaçöes da inflamaçåo em todos os pacientes estudados. A tolerabilidade foi excelente, e a maioria dos pacientes obteve resposta clínica em até 1 hora após a ingeståo do nimesulide

Efectos de la L-Dopa en la consolidación de las fracturas en Caninos

Se realizó un estudio experimental en diez pacientes caninos practicándoles Osteotomía y resección unilateral de un segmento de diáfisis femoral de 10 mm de longitud, utilizando placa de Sherman como dispositivo de distracción para mantener el intersticio formado. Un grupo de cinco pacientes recibió una dosis de I-Dopa de 1200 mg/día durante 12 días post- operatorios; cinco pacientes conformaron el grupo testigo, el cual no recibió la droga. A cada paciente se le tomó una muestra de sangre preoperatoria y cinco muestras post-operatorias con el fin de cuantificar niveles séricos de hormona del crecimiento, Somatomedina-C, Fosfatasa Alcalina, Calcio, Fosfato y Glucosa. Se tomaron placas radiográficas de control cada 30 días; los pacientes recibieron eutanasia cumplidos 90 dias post-operatorios para obtener la pieza anatomopatológica y observar las carcterísticas histopatológicas del tejido neoformado. Se hallaron diferencias estadísticas significativas entre las concentraciones séricas de las variables evaluadas entre los dos grupos de pacientes; igualmente se hallaron diferencias considerables considerables en las características radiográficas e histológicas del callo neoformado evidenciadas por la mayor densidad radiográfica y presencia abundante de callo de fractura y de callo periférico en los pacientes del grupo problema, los cuales presentaron al análisis microscópico, abundante formación de espículas óseas con un estroma ricamente vascular y celularizado. El análisis conjunto de los hallazgos séricos radiográficos e histopatológicos confirmó la excelente respuesta en la formación de callo óseo en los pacientes que recibieron levodopa