[Effectiveness analysis of arthroscopic reconstruction of posterior cruciate ligament with embedded "tibial tendon bolt" fixation].

Objective: To evaluate the effectiveness of arthroscopic reconstruction of posterior cruciate ligament (PCL) with embedded "tibial tendon bolt" fixation. Methods: The clinical data of 32 patients who underwent arthroscopic reconstruction of PCL using embedded "tibial tendon bolt" fixation through the tibial "8"-shaped tunnel between February 2012 and April 2016 were analyzed retrospectively. There were 23 males and 9 females, aged 15-57 years (mean, 39.9 years). The causes included traffic accident injury in 12 cases and sports injury in 20 cases. The clinical manifestations were swelling of knee joint, tenderness of knee joint space, and (+) Ⅲ degree in posterior drawer test; McMurry test (+) in 13 cases, valgus stress test (+) in 8 cases, Lachman test (+) in 9 cases, and Dial test (+) in 2 cases. The preoperative Lysholm score was 18.8±10.9, the International Knee Documentation Committee (IKDC) score was 18.0±15.2, and the detection value of KT-1000 was (14.34±2.73) mm. The time from injury to operation was 8-225 days, with a median of 11 days. Results: All 32 patients were followed up 25-36 months, with an average of 26.4 months. The patients had no tenderness of joint space, and the McMurry tests were all (-). At last follow-up, the Lysholm score and IKDC score were 90.2±2.4 and 87.2±6.2, respectively, which were significantly improved when compared with preoperative ones (t=-38.400, P<0.001; t=-27.190, P<0.001). The results of posterior drawer test were (-) in 21 cases, (+) Ⅰ degree in 9 cases, and (+) Ⅱ degree in 2 cases. At 1 and 2 years after operation, the detection value of KT-1000 were (5.56±2.28) mm and (5.87±1.78) mm, respectively, which were significantly improved when compared with preoperative values (P<0.05). Conclusion: The application of arthroscopic reconstruction of PCL using embedded "tibial tendon bolt" fixation through the tibial "8"-shaped tunnel is an effective, simple, and safe surgical procedure.

Arthroscopic Reconstruction of Posterior Cruciate Ligament with Embedded Tibial Tendon Bolt.

OBJECTIVE: To evaluate the effect of newly designed arthroscopic reconstruction of posterior cruciate ligament (PCL) using tibial tendon bolt. METHODS: The effects of embedded tendon pin were observed by X-ray of knee joint. From October 2010 to September 2015, 51 PCL injury patients who met the inclusion criteria were enrolled in this retrospective study. The arthroscopically assisted reconstruction of the PCL with tibial tendon bolt was performed on all patients. Visual Analog Scale (VAS) pain score, Tegner activity score, Lysholm score, International Knee Documentation Committee (IKDC) assessment, posterior drawer test (PDT), and KT-1000 activity score were evaluated preoperatively and at 1-year postoperative and 3-year postoperative. RESULTS: The preoperative, 1-year postoperative, and 3-year postoperative IKDC score (15.8% ± 14.8%, 89.6% ± 5.8%, and 86.8% ± 5.4%), Lysholm score (17.4 ± 10.7, 91.2 ± 2.8, and 88.2 ± 3.1), VAS score (5.8 ± 1.2, 1.3 ± 0.5, and 0.6 ± 0.5), Tegner activity score (1.2 ± 0.8, 8.1 ± 0.8, and 7.4 ± 0.8), and KT-1000 score (15.6 ± 3.6, 4.5 ± 2.4, and 5.4 ± 1.8) were obtained. There were significant differences in these outcomes among preoperative, 1-year postoperative, and 3-year postoperative (all P < 0.0001). After 1- and 3-year surgery, 31 (60.8%) and 26 (51.0%) patients had the negative PDT, indicating that the PCL injury was improved. There were no postoperative complications. CONCLUSION: The application of tendon pin fixed by tibial inlay 8-shaped tibial tunnel to reconstruct PCL was an effective, simple, and safe surgical procedure for PCL injury.

5-Aza-2-deoxycytidine inhibits osteolysis induced by titanium particles by regulating RANKL/OPG ratio.

Periprosthetic osteolysis (PIO) caused by wear particles is the main cause of implant failure, which is regulated by nuclear factor κ B receptor activator ligand (RANKL)/osteoprotegerin (OPG) system. At present, there is a lack of effective drugs to prevent or treat PIO. Previous studies have confirmed that DNA methylation is closely related to postmenopausal osteoporosis and can affect the expression of OPG and RANKL. However, the relationship between DNA methylation and PIO is not clear. In this study, we investigated the inhibitory effect of 5-Aza-2-deoxycytidine (AzadC) on osteolysis induced by titanium particles in a mouse model. This inhibition mechanism is achieved by changing the ratio of RANKL/OPG in the osteolysis model. In conclusion, there is a relationship between DNA methylation and PIO. AzadC has a certain inhibitory effect on osteolysis induced by titanium particles. Regulating DNA methylation may be a new way to treat PIO. Our findings lay a foundation for epigenetic understanding and intervention of osteolysis.

A comparative study of clinical effect of total knee arthroplasty in the treatment of primary osteoarthritis and osteoarthritis of Kashin-Beck disease.

OBJECTIVE: To evaluate the clinical efficacy of total knee arthroplasty (TKA) in the treatment of primary osteoarthritis (OA) and osteoarthritis of Kashin-Beck disease (KBD). METHODS: This study enrolled 77 KBD patients (77 knees, KBD-TKA) and 75 OA patients (75 knees, OA-TKA) who underwent TKA from September 2008 to June 2018. Clinical assessments for each patient were performed pre-operatively and last follow-up. The efficacy measures included the visual analogue scale (VAS) pain score, range of motion (ROM), Hospital for Special Surgery (HSS) score, and short form 36 Health Survey (SF-36) as well as related influencing factors between the two groups. RESULTS: All patients were followed up; the follow-up time of KBD-TKA was 14-132 months, with an average of 72.68 ± 37.55 months; OA-TKA was 15-120 months, with an average of 49.2 ± 28.91 months. There was no difference in pre-operative VAS score (7.29 vs. 7.24) and SF-36 (PCS) score (4.87 vs. 5.49) between KBD-TKA and OA-TKA (P > 0.05), while compared with OA, KBD-TKA had significantly worse pre-operative ROM (75.48° vs. 82.87°), HSS score (36.40 vs. 41.84), and SF-36 (MCS) score (26.28 vs. 28.73) (P < 0.05). At the final follow-up, there was no significant difference in VAS score (1.13 vs. 1.16), ROM (105.79 vs. 105.79), and HSS score (92.06 vs. 92.25) between KBD-TKA and OA-TKA (P > 0.05), while compared with OA, KBD-TKA had significantly worse SF-36 (PCS) score (36.90 vs. 42.00) and SF-36 (MCS) score (55.16 vs. 59.70) (P < 0.05). In a multivariate regression, controlling for multiple potential confounders, diagnosis of KBD was associated with poor quality of life after surgery, whereas pre-operative pain was specifically associated with post-operative pain. However, preoperative gender, age, BMI, and the angles of knee prosthesis (before and after surgery) were not associated with post-operative outcome. CONCLUSION: Patients with KBD undergoing primary TKA have excellent outcomes, comparable with OA at the final follow-up, in spite of worse pre-operative ROM, HSS score, and SF-36(MCS) score. However, KBD patients are worse than OA in terms of general health. Pre-operative age, gender, BMI, and the angles of knee prosthesis were not the factors influencing the clinical efficacy of TKA. The diagnosis of KBD was an independent risk factor for poor quality of life after TKA. Pre-operative pain was a clinically important predictor of outcome.

Serum amino acid metabolic profiles of ankylosing spondylitis by targeted metabolomics analysis.

BACKGROUND: Ankylosing spondylitis (AS) is a common chronic inflammatory arthritis, causing lasting back pain with progressive loss of spinal mobility. However, the exact pathogenesis of AS remains unclear. We aim to use the metabolomics analysis to characterize the metabolic profile of AS, in order to better understand the pathogenesis of AS and monitor disease activity and progression. METHODS: The ultra-high performance liquid chromatography-triple quadrupole mass spectrometry (UPLC-TQ-MS) was used for investigating the serum amino acid metabolomic profiling of 30 AS patients, in comparison with 32 rheumatoid arthritis (RA) patients and 30 healthy controls, combined with multivariate statistical analysis. Metabolite association analysis with disease activity was performed using generalized linear regression. The metabolic pathway analysis for the important metabolites was performed using MetPA and the metabolic network was constructed. RESULTS: A total of 29 amino acids and biogenic amines were detected in all participants by UPLC-TQ-MS. It showed significant amino acid differences between the AS/RA patients and control subjects. Additionally, 4-hydroxy-L-proline, alanine, γ-aminobutyric acid, glutamine, and taurine were identified as candidate markers shared by AS/RA groups. Specifically, lysine, proline, serine, and alanine were found correlated with disease activity of AS. Furthermore, the most significant metabolic pathway identified were alanine, aspartate, and glutamate metabolism, arginine and proline metabolism, aminoacyl tRNA biosynthesis and glycine, serine, and threonine metabolism. CONCLUSIONS: These preliminary results demonstrate that UPLC-TQ-MS analysis method is a powerful tool to identify metabolite profiles of AS. Research in identified disease activity-associated metabolites and biological pathways may provide assistance for clinical diagnosis and pathological mechanism of AS. Key Points • There are perturbations of serum amino acid metabolism in AS, compared with RA and healthy controls, determined by UPLC-TQ-MS. • Metabolomics pathway is used to analysis for the differential metabolites of AS. • The altered serum amino acid could monitor disease activity of AS.

The protective effects of GLP-1 receptor agonist lixisenatide on oxygen-glucose deprivation/reperfusion (OGD/R)-induced deregulation of endothelial tube formation.

Acute myocardial infarction (AMI) is a complication of atherosclerosis that takes place in coronary arteries. Cardiac endothelial cells play a significant role in the pathogenesis of AMI. Oxygen-glucose deprivation/reperfusion (OGD/R) is widely used as a model to simulate AMI in vitro. Recently, antidiabetic GLP-1 receptor agonists have been shown to exert pleiotropic effects that modulate cardiovascular complications. In this study, we investigated the vascular effect of lixisenatide. We show that pre-treatment of endothelial cells with lixisenatide protected them from OGD/R-induced cytotoxicity and improved their viability. Pre-treatment with lixisenatide ameliorated OGD/R-induced ROS accumulation and disturbed endothelial tube formation. At the molecular level, lixisenatide mitigated OGD/R-induced reduced eNOS expression and NO production but further promoted the expression of the anti-oxidant regulators Nrf2 and HO-1. Mechanistically, we confirmed that the PI3K/Akt pathway is essential for mediating the effects of lixisenatide, and blockage of PI3K/Akt using the inhibitor LY294002 abolished the ameliorative effect of lixisenatide on ROS production and impaired tube formation. These data indicate that lixisenatide possesses a beneficial effect on the vasculature in a model of ischemia-induced endothelial injury. We conclude that the GLP-1 receptor agonist lixisenatide has pleiotropic properties that can modulate vascular function independent of its anti-glycemic effect.

Enhanced tendon-bone healing with acidic fibroblast growth factor delivered in collagen in a rabbit anterior cruciate ligament reconstruction model.

BACKGROUND: The objective of the present study was to investigate the effectiveness of acidic fibroblast growth factor delivered in collagen (aFGF/collagen) for promoting tendon-bone interface healing after anterior cruciate ligament (ACL) reconstruction in rabbits. METHODS: ACL reconstructions were performed in the right hind limbs of New Zealand rabbits. Each left long digital extensor tendon was harvested as an autograft, and collagen incorporating different concentrations of aFGF or same amount of collagen alone was applied at the tendon-bone interface after ACL reconstruction. The control group underwent ACL reconstruction only. There were high and low aFGF/collagen groups, collagen alone group, and control group (n = 21 rabbits per group). Histological and biomechanical analyses were performed at 4, 8, and 12 weeks postoperatively to evaluate the effect of aFGF/collagen on tendon-bone interface healing. RESULTS: Results of biomechanical tests showed that at both 8 and 12 weeks postoperatively, the elastic modulus and stiffness in both the high and low aFGF/collagen treatment groups were significantly higher than those in the control group and collagen alone group, with that in the high aFGF/collagen concentration group being the highest. Histological analysis showed that at 8 weeks, tightly organized Sharpey-like fibers were observed in both aFGF/collagen groups with new bone growth into the tendon in the high concentration group. At 12 weeks postoperatively, a fibrocartilage transition zone was observed in the bone tunnels in both aFGF/collagen groups, especially in the high aFGF/collagen group. CONCLUSION: Application of the aFGF/collagen composite could enhance early healing at the tendon-bone interface after ACL reconstruction, especially with the use of a high aFGF/collagen concentration.

Knockdown of Linc00515 Inhibits Multiple Myeloma Autophagy and Chemoresistance by Upregulating miR-140-5p and Downregulating ATG14.

BACKGROUND/AIMS: The purpose of our experiments was to investigate the targeting relationship of linc00515, miR-140-5p and ATG14 and to explore the roles of linc00515, miR-140-5p and ATG14 in autophagy and chemoresistance of melphalan-resistant multiple myeloma cells. METHODS: Plasmids that could interfere with the expression of linc00515 and ATG14 were loaded into myeloma cells, which were cultured with melphalan. MTT assay and flow cytometry analysis were utilized to investigate the effect of linc00515, miR-140-5p and ATG14 on the resistance of myeloma cells. QRT-PCR was used to determine the levels of mRNAs. Western blot was utilized to explore the level of ATG14 and autophagy-related proteins. Dual luciferase assay was utilized to explore the targeting relationship between linc00515, miR-140-5p and ATG14. GFP LC3 fluorescence assay was conducted to study the autophagy of cells. RESULTS: The expression of linc00515 and ATG14 were significantly higher in melphalan-resistant myeloma cells. Knockdown of linc00515 and ATG14 led to decreased autophagy and chemoresistance of melphalan-resistant myeloma cells. The forced expression of miR-140-5p suppressed autophagy and chemoresistance of melphalan-resistant myeloma cells. CONCLUSION: Linc00515 enhanced autophagy and chemoresistance of melphalan-resistant myeloma by directly inhibiting miR-140-5p, which elevated ATG14 level.

[Application of interrupted suture at exercise position in total knee arthroplasty].

Objective: To investigate the effectiveness of interrupted suture under exercise position in total knee arthroplasty (TKA). Methods: Eighty-four patients with osteoarthritis who were treated with TKA between July 2015 and July 2016 were enrolled in the study. All patients were randomly divided into control group and observation group with 42 cases in each group. There was no significant difference in gender, age, side, body mass index, and osteoarthritis grading between 2 groups ( P>0.05). The incisions were interrupted sutured at the knee flexion position in control group and at the exercise position in observation group. Preoperative and postoperative treatments of 2 groups were same. The incision length, suture time, total tramadol usage, intraoperative blood loss, stitches removal time, hospitalization time, incidence of postoperative complication, the incision healing score (HWES), and satisfaction score of incisional self evaluation (Liktert score) were recorded and compared between 2 groups. The visual analogue scale (VAS) score was used to evaluate the incision pain at pre- and post-operation. The hospital for special surgery (HSS) score and range of motion (ROM) were also used to assess the knee function. Results: There was no significant difference in incision length, incidence of postoperative complication, HWES score, stitching time, and hospitalization time between 2 groups ( P>0.05). The suture time, intraoperative blood loss, and Likter score were significantly lower in control group than those in observation group ( P<0.05), but the total tramadol usage was significantly higher in control group than that in observation group ( P<0.05). All patients were followed up. The follow-up time ranged from 12 to 24 months (mean, 14.7 months) in control group and from 12 to 23 months (mean, 15.3 months) in observation group. There was no significant difference in VAS scores between 2 groups before operation, before going to bed at the 1st day, and after suture removal ( P>0.05). The VAS score of observation group after flexion and extension exercises at the 1st day was significantly lower than that of control group ( P<0.05). There was no significant difference in HSS score and ROM between 2 groups before operation and at 12 months after operation ( P>0.05). The HSS score and ROM in observation group at discharge and at 1, 3, and 6 months after operation were superior to those in control group ( P<0.05). Conclusion: Compared with interrupted suture at flexion knee position, the application of interrupted suture at exercise positon in TKA had the advantages of less postoperative pain and good incision healing, and can get satisfactory early joint function recovery. But significant difference in the long-term effectiveness of the two methods was not found.

[ARTHROSCOPIC STUDY OF REMNANT-PRESERVED RECONSTRUCTION OF ANTERIOR CRUCIATE LIGAMENT].

OBJECTIVE: To investigate the value of ligament remnant preservation during anterior cruciate ligament (ACL) reconstruction by observing the integrity, the tension, the synovial membrane covering, and the color of the reconstructed ligament under arthroscopy. METHODS: Between January 2011 and December 2013, 122 patients who underwent ACL reconstruction and arthroscopic internal fixation removal at 1 year after reconstruction were included in this study. Of these cases, 61 cases underwent ACL reconstruction using the remnant-preserved technique (preservation group); the other 61 cases underwent ACL reconstruction using non remnant-preserved technique (non preservation group). There was no significant difference in gender, age, injury side, body mass index, type of injury, the time from injury to reconstruction, and the result of KT-2000 examination between 2 groups (P > 0.05). The reconstructed ACL were observed under arthroscopy when internal fixation was removed, and the effectiveness was evaluated according to the criteria of AO Yingfang. RESULTS: In preservation group, the results were excellent in 34 cases, good in 22 cases, fair in 4 cases, and poor in 1 case; and in non preservation group, the results were excellent in 29 cases, good in 20 cases, fair in 10 cases, and poor in 2 cases; and there was no significant difference between 2 groups (Z= -1.320, P=0.187). CONCLUSION: In ACL reconstruction, the remnant-preserved technique is not obviously better than non remnant-preserved technique in the integrity, tension, membrane covering, and color.

Screening feature genes of osteosarcoma with DNA microarray: a bioinformatic analysis.

To screen differentially expressed genes (DEGs) of Osteosarcoma (OS) by using the microarray expression profiles of tissues of normal person and patients with OS for early diagnosis and effective treatment of OS. We downloaded the gene expression profile of GES16088 from Gene Expression Omnibus database, including twenty samples from fourteen patients diagnosed with osteosarcoma and six normal samples as control groups. We identified the DEGs by Affy package in R language. Bioinformatic methods were used for further analysis of the screened DEGs. Firstly, cluster analysis was performed on the selected DEGs for comparison of the expression degree. After protein-protein interaction (PPI) network of differentially expressed genes was constructed by STRING, we analyzed gene functions with DAVID and WebGestalt. Compared with the control, we screened three distinctly up-regulated genes. These DEGs had close relationship with transmission signaling pathway, organ and system development. The up-regulated gene COL was the most representative genes among the DEGs. The screened DEGs have a great significance on studying mechanism of osteosarcoma. It might distinguish normal and pathological tissues of OS and thus become target genes for monitoring, diagnosis and treatment of the OS. It has the potential to use in clinic.

Actinomycin D inhibits cell proliferations and promotes apoptosis in osteosarcoma cells.

Actinomycin D (ActD), a well known transcription inhibitors, has been widely reported to induce cell apoptosis in several types of tumor cells by inhibiting the anti-apoptotic gene transcriptions. However, how ActD affects osteosarcoma cells survival and its molecular mechanism is currently unclear. In the present study, results of proliferation assays and Hoechst stainings suggested that MG63 human osteosarcoma cells showed impaired cell proliferations and significant apoptosis after ActD treatment. Moreover, biochemical results showed that cleaved caspase-3 is gradually increased with the increasing ActD concentrations and treated times. Importantly, results of western blots indicated that protein levels of cyclin factors, such as cyclin A, D1 and E, were all reduced after ActD treatment. And ActD treatments may inhibit mRNA transcription levels of these cyclin factors, which may finally lead to cell cycle arrest and consequently apoptosis. The present study have revealed a novel mechanism by which ActD inhibits osteosarcoma cell proliferations and induces apoptosis, and will provide an useful clue to chemotherapy in future treatment of osteosarcoma.

Comparison of the operation of arthroscopic tibial inlay and traditional tibial inlay for posterior cruciate ligament reconstruction.

OBJECTIVE: To perform dual-bundle reconstruction of posterior cruciate ligament using full arthroscopic tibial inlay technology with self-designed tibia tunnel drilling system and to compare the effect of arthroscopic tibial inlay versus traditional technique for posterior cruciate ligament reconstruction. MATERIAL AND METHODS: 32 patients were randomly divided into experiment group (improved tibial inlay, n = 17) and control group (traditional tibial inlay, n = 15). Self-designed tibia tunnel drill system was used to produce intraoperative deep-limited bone tunnel. During follow-up, the location of the bone block and the healing situation were checked by knee X-ray and spiral CT scan. Blood loss, operation time and nerve vascular injuries were evaluated. RESULTS: Mean intraoperative blood loss was 123.53 ± 74.05 ml in the improved tibial inlay group compared with 332 ± 114.26 ml in the traditional tibial inlay group (t = 6.12, P < 0.05). Mean operation time was 235.27 ± 58.88 min in the improved tibial inlay group compared with 346.37 ± 59.67 min in the traditional tibial inlay group (t = 5.19, P < 0.05). Posterior drawer test were negative in 15 cases, slight positive in 2 with improved tibial inlay technique compared with 14 negative cases and 2 positive cases of traditional tibial Inlay technique. The X-ray and spiral CT scan showed the location of the bone block were perfect and healed well with the patent who received improved tibial inlay technology after 12 weeks postoperatively. CONCLUSION: Accurate depth-limited bone tunnel can be produced by the tibia tunnel drill system with minor trauma, less bleeding and reducing of nerves or vessels and the recent clinical effects of PCL reconstruction were pretty good.