Failure modes after anterior cruciate ligament reconstruction: a systematic review and meta-analysis.

PURPOSE: The reason for graft failure after anterior cruciate ligament reconstruction (ACLR) is multifactorial. Controversies remain regarding the predominant factor and incidence of failure aetiology in the literature. This review aimed to provide a meta-analysis of the literature to evaluate the relative proportion of various failure modes among patients with ACLR failure. METHODS: The PubMed, Embase, Cochrane Library, Web of Science, and EBSCO databases were searched for literature on ACLR failure or revision from 1975 to 2021. Data related to causes for ACLR surgical failure were extracted, and a random effects model was used to pool the results, which incorporates potential heterogeneity. Failure modes were compared between different populations, research methods, graft types, femoral portal techniques, and fixation methods by subgroup analysis or linear regression. Funnel plots were used to identify publication bias and small-study effects. RESULTS: A total of 39 studies were analyzed, including 33 cohort studies and six registry-based studies reporting 6578 failures. The results showed that among patients with ACLR failure or revision, traumatic reinjury was the most common failure mode with a rate of 40% (95% CI: 35-44%), followed by technical error (34%, 95% CI: 28-42%) and biological failure (11%, 95% CI: 7-15%). Femoral tunnel malposition was the most common cause of the technical error (29%, 95% CI: 18-41%), with more than two times higher occurrence than tibial tunnel malposition (11%, 95% CI: 6-16%). Traumatic reinjury was the most common factor for ACLR failure in European populations and in recent studies, while technical errors were more common in Asian populations, earlier studies, and surgery performed using the transtibial (TT) portal technique. Biological factors were more likely to result in ACLR failure in hamstring (HT) autografts compared to bone-patellar tendon-bone (BPTB) autografts. CONCLUSION: Trauma is the most important factor leading to surgical failure or revision following ACLR. Technical error is also an important contributing factor, with femoral tunnel malposition being the leading cause of error resulting in failure.

Comparison of femoral mechanics before and after internal fixation removal and the effect of sclerosis on femoral stress: a finite element analysis.

BACKGROUND: Femoral neck fractures are a common traumatic injury. The removal of the internal fixation remains controversial, especially in terms of mechanical stability. Moreover, collapsed necrosis of the femoral head continues to occur after fracture healing. We believe that sclerotic cancellous bone (SCB) formation around the screw is associated with femoral head necrosis. We aimed to compare mechanical features before and after implant removal and determine the effect of SCB formation on stress distribution. METHODS: Cylindrical cancellous bone sections were collected from a relatively normal region and an SCB region of a necrotic femoral head, and their elastic moduli were measured. Four femoral finite element models were developed: a) femoral neck fracture healing with implants, b) fracture healing without implants, c) sclerosis around the screw with implants, and d) sclerosis around the screw without implants. RESULTS: The maximum von Mises peak stresses of models a and b were 66.643 MPa and 63.76 MPa, respectively, and were concentrated in the upper lateral femur. The main stress was scattered at the lowest screw tail, femoral calcar region, and lateral femur shaft. Moreover, coronal plane strain throughout the screw paths near the femoral head in models a and b was mostly in the range of 1000-3000 µÎµ. The maximum stress concentrations in models c and d were located at the lower femoral head and reached 91.199 MPa and 78.019 MPa, respectively. CONCLUSIONS: The stresses in the sclerotic model around the cannulated screws are more concentrated on the femoral head than in the healing model without sclerotic bone. The overall stresses in the healing femoral neck fracture model were essentially unchanged before and after removal of the internal fixation.

Effect of celecoxib combined with glucosamine hydrochloride in promoting the functional recovery and decreasing the inflammatory factor levels in patients with knee osteoarthritis.

To explore the role of celecoxib with glucosamine hydrochloride on functional recovery and reduction of inflammatory factors in patients with knee osteoarthritis. Altogether 128 patients with knee osteoarthritis in the middle and early stage admitted to our hospital from January 2018 to July 2019 were selected and grouped into the control group (CG) (celecoxib tablet therapy) and the combination group (ComG) (celecoxib combined with glucosamine hydrochloride therapy). Blood routine indexes and inflammatory factor levels before and after intervention, Lequesne score, VAS pain and adverse reactions of the two groups of patients before and after intervention were explored. Before intervention, there was no evident difference between the two groups in each index (P>0.05). After intervention, the blood routine index IgM rheumatoid factor, albumin/globulin, erythrocyte sedimentation rate and inflammatory factors TNF-α, IL-6, IL-1ß, hs-CRP levels in the ComG were evidently better than those in the CG, while Lequesne score and VAS pain score were lower than those in the CG (P<0.01). The total incidence of adverse reactions in the ComG was evidently lower than that in the CG. Celecoxib combined with glucosamine hydrochloride is effective in the treatment of knee osteoarthritis and has little adverse reactions.

[Current therapy progress on the acute patellar dislocation].

The treatment of acute patellar dislocation remains a topic of debate among orthopedic surgeons. While conservative treatment has traditionally been favored, recent studies have highlighted the high redislocation rate, prompting a reevaluation of treatment strategies. Current approaches recognize the importance of addressing not only the knee joint but also associated factors contributing to instability. Surgical intervention, particularly focusing on restoring patellar stability through medial patella-femoral ligament (MPFL), repair or reconstruction, has gained popularity. MPFL reconstruction can provide long-term stability of the patella, but further research is needed. When acute patellar dislocation is associated with abnormal bony factors, multiple surgical modalities are often required, with the goal of restoring the normal trajectory of the patella, maintaining the stability of the patellofemoral joint, and optimizing knee joint function. This review provides an overview of advances in the treatment of acute patellar dislocation and related problems, so as to provide reference for clinicians.

The silencing of NREP aggravates OA cartilage damage through the TGF-ß1/Smad2/3 pathway in chondrocytes.

Background: Osteoarthritis (OA) is a common chronic degenerative joint disease. Due to the limited understanding of its complex pathological mechanism, there is currently no effective treatment that can alleviate or even reverse cartilage damage associated with OA. With improvement in public databases, researchers have successfully identified the key factors involved in the occurrence and development of OA through bioinformatics analysis. The aim of this study was to screen for the differentially expressed genes (DEGs) between the normal and OA cartilage through bioinformatics, and validate the function of the TGF-ß1/Smad2/3 pathway-related neuron regeneration related protein (NREP) in the articular cartilage. Methods: The DEGs between the cartilage tissues of OA patients and healthy controls were screened by bioinformatics, and functionally annotated by Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses. The expression levels of the DEG in human and murine OA cartilage was verified by reverse transcription-quantitative PCR (RT-qPCR), Western blotting and immunohistochemistry (IHC). RT-qPCR, Western-blotting, Cell Counting Kit-8(CCK8) and EdU assays were used to evaluate the effects of knocking down NREP in normal chondrocytes, and the molecular mechanisms were investigated by RT-qPCR, Western blotting and IHC. Results: In this study, we identified NREP as a DEG in OA through bioinformatics analysis, and found that NREP was downregulated in the damaged articular cartilage of OA patients and mouse model with surgically-induced OA. In addition, knockdown of NREP in normal chondrocytes reduced their proliferative capacity, which is the pathological basis of OA. At the molecular level, knock-down of NREP inactivated the TGF-ß1/Smad2/3 pathway, resulting in the downregulation of the anabolic markers Col2a1 and Sox9, and an increase in the expression of the catabolic markers MMP3 and MMP13. Conclusion: NREP plays a key role in the progression of OA by regulating the TGF-ß1/Smad2/3 pathway in chondrocytes, and warrants further study as a potential therapeutic target.

[Study on application of posterior tibial slope angle in anterior cruciate ligament].

Posterior tibial slope angle (PTSA) is a risk factor for anterior cruciate ligament (ACL) injury and has attracted a lot of attention, but its mechanism of action and diagnosis are still not systematically studied in the field of sports medicine. In this paper, we believe that PTSA should be measured by full-length lower extremity films and combined with multiple imaging data for comprehensive assessment to reduce errors. A large PTSA may increases risk of anterior cruciate ligament injury, so patients with more than 12 degrees of PTSA should be treated by preserving meniscus as much as possible during ACL reconstruction and combining with tibial osteotomy if necessary, which could effectively prevent risk of ligament re-injury. At the same time, gait analysis has an important reference value for preoperative pathogenic pattern and postoperative rehabilitation function, so the author believes that it will have a guiding significance for the development of individualized rehabilitation strategy based on PTSA, in order to achieve the best treatment effect.

DNAJB4 promotes triple-negative breast cancer cell apoptosis via activation of the Hippo signaling pathway.

INTRODUCTION: Triple-negative breast cancer (TNBC) is currently the most malignant subtype of breast cancer without effective targeted therapies. DNAJB4 (Dnaj heat shock protein family (Hsp40) member B4) is a member of the human heat shock protein family (Hsp40). The clinical significance of DNAJB4 in breast cancer has been reported in our previous study. However, the biological function of DNAJB4 in TNBC cell apoptosis remains unclear to date. METHODS: The expression of DNAJB4 in normal breast cells, breast cancer cells, four-paired TNBC tissues, and adjacent noncancerous tissues was quantified by quantitative real-time polymerase chain reaction (qRT-PCR) and western blot assay. The role of DNAJB4 in TNBC cell apoptosis was investigated using a number of gain- and loss-of-function in vitro and in vivo assays. The underlying molecular mechanisms in TNBC cell apoptosis were elucidated via Western blot assay. RESULTS: DNAJB4 expression was significantly downregulated in TNBC tissues and cell lines. DNAJB4 knockdown inhibited TNBC cell apoptosis and promoted tumorigenicity in vitro and in vivo, but DNAJB4 overexpression resulted in the opposite. Mechanically, DNAJB4 knockdown inhibited TNBC cell apoptosis through suppression of the Hippo signaling pathway, and the result was reversed after DNAJB4 overexpression. CONCLUSIONS: DNAJB4 promotes TNBC cell apoptosis by activating the Hippo signaling pathway. Therefore, DNAJB4 may act as a prognostic biomarker and therapeutic target for TNBC.

Research progress and hotspots on macrophages in osteoarthritis: A bibliometric analysis from 2009 to 2022.

BACKGROUND: Macrophages in the synovium, as immune cells, can be polarized into different phenotypes to play an anti-inflammatory role in the treatment of osteoarthritis. In this study, bibliometric methods were used to search the relevant literature to find valuable research directions for researchers and provide new targets for osteoarthritis prevention and early treatment. METHODS: Studies about the application of macrophages in the treatment of osteoarthritis were searched through the Web of Science core database from 2009 to 2022. Microsoft Excel 2019, VOSviewer, CiteSpace, R software, and 2 online websites were used to analyze the research status and predict the future development of the trend in research on macrophages in osteoarthritis. RESULTS: The number of publications identified with the search strategy was 1304. China and the United States ranked first in the number of publications. Shanghai Jiao Tong University ranked first in the world with 37 papers. Osteoarthritis and Cartilage was the journal with the most publications, and "exosomes," "stem cells," "macrophage polarization," "regeneration," and "innate immunity" may remain the research hotspots and frontiers in the future. CONCLUSION: The findings from the global trend analysis indicate that research on macrophages in the treatment of osteoarthritis is gradually deepening, and the number of studies is increasing. Exosomes may become a research trend and hotspot in the future.

[Hemostatic efficacy of tranexamic acid and ε-aminocaproic acid in hip and knee arthroplasty:a Meta-analysis].

OBJECTIVE: To systematically evaluate the hemostatic efficacy of tranexamic acid and ε-aminocaproic acid in total hip arthroplasty (THA) and total knee arthroplasty (TKA). METHODS: Randomized controlled trials (RCT) and retrospective case-control studies about tranexamic acid and ε-aminocaproic acid for the comparison of THA or TKA were searched electronically in PubMed, EMbase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang, VIP from the time of building databases to July 2020. Two investigators carried out literature screening and data extraction according to the inclusion and exclusion criteria respectively. The methodological quality of the included randomized controlled studies was evaluated through the Cochrane Handbook, and the methodological quality of the included retrospective case-control studies was evaluated through the NOS scale. Blood loss, the incidence of thrombosis complications, per capita input of hemoglobin were Meta-analyzed by Review Manager 5.3 software. RESULTS: A total of 6 articles were included, including 4 RCTs and 2 retrospective case-control studies. A total of 3 174 patients, including 1 353 in the tranexamic acid group and 1 821 in the ε-aminocaproic acid group. Meta-analysis results showed that there were no difference statistical significance in blood loss [MD=-88.60, 95%CI(-260.30, 83.10), P=0.31], blood transfusion rate [OR=1.48, 95%CI(0.96, 2.27), P=0.08], thrombotic complications [OR=0.80, 95%CI(0.07, 8.83), P=0.85], per capita hemoglobin input [MD=0.04, 95%CI(-0.02, 0.10), P=0.18] between tranexamic acid group and ε-aminocaproic acid group during THA. While in TKA, the blood loss of the tranexamic acid group was less than that of the ε-aminocaproic acid group [MD=-147.13, 95%CI(-216.52, -77.74), P<0.0001], the difference was statistically significant. The blood transfusion rate [OR=1.30, 95%CI(0.74, 2.28), P=0.37], thrombotic complications [OR=0.95, 95%CI(0.38, 2.36), P=0.92], per capita hemoglobin input [MD=-0.00, 95%CI(-0.05, 0.06), P=0.48], tourniquet time [MD=1.54, 95%CI(-2.07, 5.14), P=0.40] were similar between two groups, the difference was not statistically significant. CONCLUSION: In THA, tranexamic acid and ε-aminocaproic acid have similar hemostatic effects, while in TKA, tranexamic acid can effectively reduce the patient's blood loss and has a better hemostatic effect. Tranexamic acid is recommended as one of the first choice hemostatic drugs for TKA.

[Effect of knee arthroscopy on subsequent total knee arthroplasty: Meta-analysis].

OBJECTIVE: To evaluate effect of knee arthroscopy on prognosis of subsequent total knee arthroplasty (total knee arthroplasty, TKA) by Meta-analysis. METHODS: Databases including PubMed, Embase, Cochrane Library, CNKI, Wanfang and other databases were searched by computer from establishing to October 2020 to collect literatures on effect of knee arthroscopy on prognosis of subsequent TKA. Quality evaluation and data extraction were carried out according to inclusion, exclusion criteria and literature screening. Newcastle-Ottawa Scale (NOS) was used to evaluate literature quality of non-randomized controlled studies. RevMan 5.3 software was applied to Meta-analysis on revision rate, reoperation rate, postoperative stiffness rate, periprosthetic infection rate, postoperative venous thrombosis venous thromboembolism(VTE) rate and postoperative knee flexion range of motion after TKA. RESULTS: Eight literatures were finally included with totally sample size of 182 815 patients. Among them, 6 998 patients were in knee arthroscopy group and 175 817 patients were in knee arthroscopy group. Meta-analysis results showed that there were statistical differences in revision rate after TKA[OR=1.66, 95%CI(1.37, 2.00), P<0.000 01], re-operation rate[OR=2.31, 95%CI(1.59, 3.36), P<0.000 1], postoperative stiffness rate[OR=1.78, 95%CI(1.02, 3.11), P=0.04] and infection rate around prosthesis[OR=1.40, 95%CI(1.19, 1.66), P<0.000 1]. While there were no difference in VTE rate[OR=1.06, 95%CI(0.83, 1.35), P=0.64], postoperative knee flexion range of motion[MD=-1.21, 95%CI(-3.07, 0.65), P=0.20]. CONCLUSION: Knee arthroscopy has a negative impact on subsequent TKA surgery. Previous arthroscopic increased risk of stiffness, periprosthetic joint infection, revision and reoperation after TKA, but there was no significant difference in postoperative knee flexion range of motion and incidence of VTE.

Evaluation of Minimally Invasive Arthroscopy Technology in Sports Medicine-An Evaluation of Nano Silver Disinfectants.

Currently, nano silver fungicide prepared in the laboratory is used to disinfect arthroscopic surgical instruments. In this study, nano silver fungicides with stable properties were prepared and characterized. Afterwards, their bactericidal properties as well as mucus peeling properties were further tested. The results show that the nano silver fungicide prepared here contains uniform particle size and displays material stability for 60 days. Nano silver fungicide can completely kill sulfate-reducing bacteria, anaerobic bacteria, and iron reducing bacteria, while the slime stripping rate is 80.58%. Additionally, we propose the use of nano silver sterilization agents to kill the arthroscopic surgical instruments in conjunction with proper manual cleaning, as they can effectively kill all the bacteria on the surgical instruments, achieving a sterilization rate of 99.99%.

[Comparison of femoral tunnel and early curative effect analysis between arthroscopic three approach and traditional anteromedial portal for reconstruction of anterior cruciate ligament].

OBJECTIVE: To study the three-approach and traditional anterior medial technique to establish the femoral tunnel of position, length, and coronal angle and the early efficacy of anterior cruciate ligament reconstruction. METHODS: Through retrospective research, from December 2018 to June 2019, a total of 36 patients diagnosed with simple anterior cruciate ligament tear and undergoing surgery were collected. All patients had a clear history of knee sprains and were divided into two groups. A group of 16 patients, including 11 males and 5 females, with an average age of (30.13±6.54) years and an injury time of 7 to 60 (30.19±15.78) days, three-approach technique was used to drill the femoral tunnel to reconstruct the anterior cruciate ligament. Another group of 20patients, including 15 males and 5 females, with an average age of (30.80±8.60) years, and an injury time of 7 to 60 (27.35±15.50) days, the traditional anterior medial approach was used to drill the femoral tunnel to reconstruct anterior cruciate ligament. CT 3D reconstruction technique was used to evaluate the femoral tunnel and the knee joint function was evaluated by Lysholm score of the knee joint. RESULTS: All patients achieved primary healing after the surgical incision. No femoral tunnel fracture, vascular and nerve damage, difficulty in graft passage during the operation, and venous thrombosis occurred. All 36 patients were followed up on an outpatient basis, with a follow up period of 9 to 15 (12.00±2.83) months. Three-dimensional CT reconstruction was used to evaluate the femoral tunnel of the patients. The position of the femoral tunnel was described using the quartile method as the three-approach group:the lower (27.83±1.97) % of the femoral condyle and the posterior (25.57±3.20) %;the traditional approach group:the lower (28.38±3.21) % of the femoral condyle and the posterior (26.23±3.20) %. Bone tunnel length, three-approach group:(35.20±5.52) mm in total length, (23.20±2.07) mm in thick bone tunnel;traditional approach group:(34.60±4.26) mm in total length, (22.56±2.50) mm in thick bone tunnel. Coronal plane angle, three-approach group:(47.93±5.98) °;traditional approach group:(41.78±6.62) °. Knee joint Lysholm score, three-approach group:48.67±4.18 before surgery;97.00±2.48 at last follow up;traditional approach group:49.75±5.33 before surgery, 97.30±2.68 at last follow up, there were significant differences before and after surgery, no significant statistical difference between two groups. CONCLUSION: The positions of the femoral tunnel drilled by the two methods were within the range of the anatomic stop of the anterior cruciate ligament, and there was no statistical difference. Compared with the traditional anterior medial approach, the coronal plane angle of the femoral tunnel drilled by the three-approach approach is relatively large, and there were no statistical differences in the length of the tunnel, the early postoperative effect of the two surgical methods, and the operation time. But the three approach has a wider and clearer vision. In addition, the knee flexion angle required for drilling the femoral tunnel during surgery is significantly smaller than that of traditional approach technology, which reduces the difficulty of surgery.

Comparison of safety and efficacy between total endoscopic resection and conventional open surgery for malignant thyroid tumors: a meta-analysis.

BACKGROUND: Endoscopic thyroidectomy (ET) has been widely accepted as a surgical option for benign thyroid lesions, yet remains controversial in the treatment of malignant thyroid because of concerns with the safety and efficacies. This paper aims at systematically evaluating the advantages and disadvantages of ET in malignant thyroid tumors through meta-analyses. METHODS: Meta-analysis was conducted by retrieving all studies on the treatment of malignant thyroid carcinomas released in database, including PubMed, Web of Science, Cochrane and Google scholar, from January 2005 to January 2019. Then the safety and efficacies were compared between the two surgical modalities based on current reports. RESULTS: Totally, 3,482 cases were included in 11 related studies. Most adverse outcomes by ET were involved in transient or permanent recurrent laryngeal nerve paralysis (RLN) and hypocalcemia, postoperative total complications, hemorrhage, hematoma at the incision, and total relapse rate following surgery. Besides, ET led to higher incidence of transient RLN palsy, yet significantly lower transient hypocalcemia than conventional open thyroidectomy (COT). The difference was insignificant regarding transient or permanent RLN and hypocalcemia, total postoperative complications, postoperative hemorrhage, incisional hematoma and total recurrent rate between the two procedures. Secondary outcomes consisted of operative time, hospital stay and cosmetic results, by which COT was superior to ET, yet cosmetic incision was better by ET than by COT. There was no significant difference in hospital stay. CONCLUSIONS: ET can be feasible and safe surgical option for malignant thyroid lesions, with better cosmetic effect.

Global research status and trends of UKA for knee osteoarthritis: a bibliometric analysis.

OBJECTIVE: As an alternative of knee-protection surgery, unicompartmental knee arthroplasty has been widely used for the treatment of knee osteoarthritis and has achieved good clinical results. However, reports on its data and trend are scanty. This article reviewed current status and trend in the research of UKA, and compared different regions, organizations and authors in terms of their contributions to the field. METHODS: The literature on UKA ranging from 2009 to 2019 was searched in the "Web of Science" database, and the search results were visually presented by using Excel and VOS-viewer software packages, and the status quo and development trends of relevant studies were analyzed. RESULTS: A total of 1264 articles on UKA were identified, of which 330 were the larger studies conducted in the United States. The institution that published most papers was Oxford University, with a total of 109 papers published. MURRAY DW was the largest contributor in this field. The National Institutes of Health was the largest funding agencies of the UKA. Studies could be divided into six clusters in terms of prosthesis design, follow-up investigation, OA etiology, hip-knee association, joint replacement registration, and computer navigation. "Computer-aided navigation" and "gait analysis" promise to be future hot spots in the field of UKA research. CONCLUSION: Global trend analysis suggests that UKA research is gradually deepening and the number of papers has been on the rise. The USA was the largest contributor to this field. More research effort should be directed to "Computer-aided navigation"and "gait analysis", which might be the popular topics in the UKA field in not very distant future.

[Research progress on the application of lower limb alignment in discoid meniscus injury].

Discoid meniscus injury is a kind of common sports injury. Its treatment methods include arthroscopic discoid meniscus plasty, discoid meniscus subtotal resection, discoid meniscus total resection and so on. Although the short-term clinical effect is good, the long-term clinical effect is not ideal. At present, different scholars have different views on the choice of surgical methods for discoid meniscus injury. In recent years, many scholars have shown that the choice of operation and the change of lower limb force line are related to the therapeutic effect of discoid meniscus injury. This paper mainly summarizes the current situation of the treatment of discoid meniscus injury and the changes of the force line of the lower limbs after operation, and expounds therole of the evaluation of the force line of the lower limbs in the treatment of discoid meniscus, so as to provide the basis for the clinical individualized treatment of discoid meniscus injury.

DNAJB4 identified as a potential breast cancer marker: evidence from bioinformatics analysis and basic experiments.

BACKGROUND: Breast cancer (BC) is the leading cause of tumor-related death in women worldwide, but its pathogenesis is not clear. The efficient screening of new therapeutic targets for BC through bioinformatics and biological experimental techniques has become a hot topic in BC research. METHODS: The bioinformatics method was used to analyze the gene chips and obtain the hub genes, playing an important role in the development of BC. The biological processes (BP) involved in the hub genes were analyzed by Bingo, and the impact of each hub gene on disease-free survival (DFS) and overall survival (OS) in BC patients was evaluated in the Kaplan-Meier Plotter database. The expression of DNAJB4, the hub gene with the greatest degree and having an effect on the prognosis of BC patients, was detected in BC cell lines and clinicopathological specimens. And DNAJB4 was selected for further biological experiments and clinical prognosis verification. RESULTS: Ten hub genes including DNAJB4, the greatest degree genes, were found by bioinformatics analysis of BC gene chips. DNAJB4 expressions in both BC cell lines and clinicopathological specimens were detected and the results showed that DNAJB4 was significantly down-regulated in BC cell lines and tissues. After interfering with the expression of DNAJB4, it was found that the invasion and migration ability of MDA-MB-231 cell line was significantly enhanced in vitro. The clinical survival data of BC patients showed that patients with high DNAJB4 expression had longer DFS. CONCLUSIONS: DNAJB4 may be a tumor suppressor gene in BC as it could regulate invasion and migration of BC cells and its expression level is related to the prognosis of BC patients. Nevertheless, further researches are still necessary to verify its role in BC so as to provide evidences for clinical guidance regarding diagnosis and treatment.

Mesenchymal stem cells as a gene therapy carrier for treatment of fibrosarcoma.

BACKGROUND AIMS: Cell-based gene therapy is an alternative to viral and non-viral gene therapy. Emerging evidence suggests that mesenchymal stem cells (MSC) are able to migrate to sites of tissue injury and have immunosuppressive properties that may be useful in targeted gene therapy for sustained specific tissue engraftment. METHODS: In this study, we injected intravenously (i.v.) 1x10(6) MSC, isolated from green fluorescent protein (GFP) transgenic rats, into Rif-1 fibrosarcoma-bearing C3H/HeN mice. The MSC had been infected using a lentiviral vector to express stably the luciferase reporter gene (MSC-GFP-luci). An in vivo imaging system (IVIS 200) and Western blotting techniques were used to detect the distribution of MSC-GFP-luci in tumor-bearing animals. RESULTS: We observed that xenogenic MSC selectively migrated to the tumor site, proliferated and expressed the exogenous gene in subcutaneous fibrosarcoma transplants. No MSC distribution was detected in other organs, such as the liver, spleen, colon and kidney. We further showed that the FGF2/FGFR pathways may play a role in the directional movement of MSC to the Rif-1 fibrosarcoma. We performed in vitro co-culture and in vivo tumor growth analysis, showing that MSC did not affect the proliferation of Rif-1 cells and fibrosarcoma growth compared with an untreated control group. Finally, we demonstrated that the xenogenic MSC stably expressing inducible nitric oxide synthase (iNOS) protein transferred by a lentivirus-based system had a significant inhibitory effect on the growth of Rif-1 tumors compared with MSC alone and the non-treatment control group. CONCLUSIONS: iNOS delivered by genetically modified iNOS-MSC showed a significant anti-tumor effect both in vitro and in vivo. MSC may be used as a target gene delivery vehicle for the treatment of fibrosarcoma and other tumors.

[The risk factors of periprosthetic fracture after hip arthroplasty:a meta-analysis].

OBJECTIVE: To explore risk factors of the periprosthetic fracture after hip arthroplasty. METHODS: Potential studies were searched in databases including Pubmed, Embase, Cochrane Library, CNKI as well as Wanfang Database up to November 2018 and references in related literatures. The methodological quality of literature was estimated by Newcastle-Ottawa Scale. Raw data were merged and tested mainly by Revmain 5.3. RESULTS: Seventeen studies in total were appropriate with 90 632 patients. The results revealed that it increased the risk of periprosthetic fracture after hip arthroplasty, including female (OR=1.62, 95%CI:1.44 to 1.82, P<0.01), revision(OR=3.78, 95%CI:1.88 to 7.58, P<0.01), preoperative diagnosis of rheumatoid arthritis(OR=1.60, 95%CI:1.07 to 2.37, P=0.02). Conversely, patients involved with cemented prosthesis fixation(OR=0.43, 95%CI:0.27 to 0.68, P<0.01) were less likely to suffer periprosthetic fracture after hip arthroplasty. Other factors were not significantly relevant to periprosthetic fracture after hip arthroplasty, including the age, preoperative diagnosis(femoral head necrosis, osteoarthritis, developmental dysplasia of the hip, femoral fracture, concomitant heart diseases) and American Society of Anesthesiologists >=3. CONCLUSIONS: Orthopedics doctors should constantly be cantious about the risk factors including female, revision and diagnosis of rheumatoid arthritis. They are supposed to prevent the periprosthetic fracture by gentle operation during hip arthroplasty and monitoring the functional exercise after operations when the above risk factors occur.

[Effect of equiaxial tensile strain in early differentiation of mesenchymal stem cells into cartilage cells].

OBJECTIVE: To observe the effect of cyclic equiaxial tensile strain in the early differentiation of bone marrow mesenchymal stem cells(BMSCs) into cartilage in mouse under conditions of two-dimensional culture, and to investigate the mechanism of cyclic equiaxial tensile strain in early chondrogenic differentiation. METHODS: Sixteen KM mouse aged 4 weeks were selected, male and female unlimited, with an average weight of 19.5 g (17 to 21 g). After extracting and isolating the BMSCs from KM mouse, then subculture the BMSCs to the 3rd generation. Seed the cells in the biological plate(BioFlex). According to experimental design, the cells were divided into 6 groups, blank group: ordinary culture medium was cultured for 8 days without isometric cyclic tensile strain stimulation. Control group: chondrogenic differentiation medium was used to culture for 8 days without isometric cyclic tensile strain stimulation. Experimental group: the experimental group was divided into 4 groups, all of which were cultured with chondrogenic differentiation medium for 8 days. During which isometric cyclic tensile strain stimulation was given for 1, 3, 5 and 7 days respectively. At the 8th day, all the cells were collected, the expression of the Sox9, Col-II and ROCK 1 signaling pathway-related molecules was analyzed by RT-PCR. Cells in each group were extracted, and the efficiency of cell proliferation in each group was detected by CCK-8. Glycosaminoglycan content in medium changed last was detected using ELISA. Pericellular matrix was observed by Safranin O staining and Alcian Blue staining. Normal measurement data using mean±standard deviation compared between the blank group and control group using paired t-test, compared between the experimental group and relative group using single factor analysis of variance. RESULTS: (1)After 8 days of culture, compared with the control group, the relative expression of Sox 9 and Col-II mRNA in the experimental group increased gradually with the increase of loading time(P<0.05), while the relative expression of ROCK1 mRNA decreased(P<0.05). Compared with the blank group, the relative expression of ROCK1 mRNA in experimental group and control group increased (P<0.05). (2)With the increase of loading time, the experimental group showed a trend of decreasing at first and then increasing, but compared with the blank group and the control group, the control group decreased significantly. (3)Glycosaminoglycan content in the medium changed last was detected by ELISA. The glycosaminoglycans in the experimental group increased gradually, and the content changes on 7 days loading group were statistically significant compared with other groups(P<0.05). (4)Safranin O and Alcilan staining showed that there was a tendency of cartilage differentiation in the experimental group, and the shape gradually increased with time, which was more obvious than that in the control group; The PCM, Col-II and GAG in the experimental group increased gradually with the increase of mechanical stimulation days, which were more obvious than those in the control group. CONCLUSIONS: Under conditions of two-dimensional culture, in the early differentiation of mesenchymal stem cells into cartilage, cyclic equiaxial tensile strain can promote the proliferation of BMSCs and the differentiation into chondrocytes. Moreover, cyclic equiaxial tensile strain may promote chondrogenic differentiation through inhibiting the Rho/ROCK 1 signaling pathway.

[Classification and reconstruction of acetabular defects in revision total hip arthroplasty].

As a mature technology gradually, the total hip arthroplasty has been known and conducted by more and more orthopedic surgeons. However, it also increased the number of hip revisions. The reasons for revision of hip mainly include: unstable, infection, aseptic loosening prosthesis, prosthesis peripheral fracture, liner wear and so on, and the acetabulum bone defect and the choice of acetabular prosthesis have been perplexing surgeons. In this paper, we summarise classification and reconstruction of acetabulum bone defect in hip revision oprations, compare the advantages and disadvantages of all kinds of classification, on this basis can have more than one bone grafting mode and the choice of the acetabulum prosthesis for reconstruction of acetabulum, then expound the ways of material sources, bone grafting modes and complex acetabulum bone defect reconstruction as well as the choice of the ways of fixed prosthesis, providing the basis for clinical doctors to deal with all kinds of acetabulum bone defect and the choice of the acetabulum prosthesis, guiding patient specific therapy more precisely.