Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 46
Filtrar
Mais filtros










Base de dados
Intervalo de ano de publicação
1.
Biomaterials ; 238: 119828, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32045781

RESUMO

Magnesium (Mg)-based biometal attracts clinical applications due to its biodegradability and beneficial biological effects on tissue regeneration, especially in orthopaedics, yet the underlying anabolic mechanisms in relevant clinical disorders are lacking. The present study investigated the effect of magnesium (Mg) and vitamin C (VC) supplementation for preventing steroid-associated osteonecrosis (SAON) in a rat experimental model. In SAON rats, 50 mg/kg Mg, or 100 mg/kg VC, or combination, or water control was orally supplemented daily for 2 or 6 weeks respectively. Osteonecrosis was evaluated by histology. Serum Mg, VC, and bone turnover markers were measured. Microfil-perfused samples prepared for angiography and trabecular architecture were evaluated by micro-CT. Primary bone marrow cells were isolated from each group to evaluate their potentials in osteoblastogenesis and osteoclastogenesis. The mechanisms were tested in vitro. Histological evaluation showed SAON lesions in steroid treated groups. Mg and VC supplementation synergistically reduced the apoptosis of osteocytes and osteoclast number, and increased osteoblast surface. VC supplementation significantly increased the bone formation marker PINP, and the combination significantly decreased the bone resorption marker CTX. TNFα expression and oxidative injury were decreased in bone marrow in Mg/VC/combination group. Mg significantly increased the blood perfusion in proximal tibia and decreased the leakage particles in distal tibia 2 weeks after SAON induction. VC significantly elevated the osteoblast differentiation potential of marrow cells and improved the trabecular architecture. The combination supplementation significantly inhibited osteoclast differentiation potential of marrow cells. In vitro study showed promoting osteoblast differentiation effect of VC, and anti-inflammation and promoting angiogenesis effect of Mg with underlying mechanisms. Mg and VC supplementation could synergistically alleviate SAON in rats, indicating great translational potentials of metallic minerals for preventing SAON.

2.
Photodermatol Photoimmunol Photomed ; 36(1): 14-20, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31206787

RESUMO

PURPOSE: To compare the efficacy and safety of narrowband ultraviolet B (NB-UVB) phototherapy in home vs in hospital for the management of limited new-onset vitiligo. METHODS: Patients with new-onset vitiligo (<3 months) with <5% body surface area involvement were recruited and randomly assigned to either a home-based or a hospital-based treatment group. Both groups were administered NB-UVB phototherapy thrice a week. The body surface area (BSA) involved with vitiligo, Vitiligo Area Scoring Index (VASI), the effectiveness of repigmentation, Vitiligo Quality of Life index (VitiQoL), and the cost of treatment were examined. RESULTS: A total of 100 patients completed the study. Patients in both groups exhibited improvements demonstrated by BSA and VSAI decrease. No significant differences were found between the two groups in terms of skin repigmentation (P > 0.05). Improvements in the VitiQoL scores were reduced to the greatest degree at week 8 for all patients in both groups. Adverse events, such as painful erythema, burning, blistering, and excessive hyperpigmentation, were more frequently observed in the home-based treatment group than in the hospital-based treatment group. The cost of phototherapy in hospital exceeded the cost of home phototherapy after 7 weeks of treatment. CONCLUSIONS: Home NB-UVB phototherapy treatment was as effective as treatment in hospital, but exhibited cost-effective and a better compliance. However, the education of the patients should be strengthened to avoid excessive UVB exposure and related adverse events.

3.
Sci Rep ; 9(1): 18016, 2019 Nov 29.
Artigo em Inglês | MEDLINE | ID: mdl-31784659

RESUMO

Mechanical ocular trauma could lead to disastrous visual outcomes. There has been a controversy regarding the timing of vitrectomy for such cases. This study aimed to find out the optimal timing of vitrectomy for severe mechanical ocular trauma. Patients with severe mechanical ocular trauma who had undergone vitrectomy were enrolled and followed up for at least 6 months. Clinical data were collected including ocular trauma score (OTS), the timing of vitrectomy upon injury, visual acuity, vitrectomy results, post-operation complications and etc. All cases were classified according to the timing of vitrectomy upon injury into 3 groups: group A 1-7 days, group B 8-14 days, group C more than 14 days. A total of 62 cases were enrolled, including 20 eyes in group A, 25 eyes in group B, and 17 eyes in group C. No significant differences were shown of the gender, age or OTS among the 3 groups. Both functional success rate and visual outcome were optimal in group B, then in group A, and worst in group C. These results suggested that the best timing of vitrectomy for severe mechanical ocular trauma is 8-14 days upon injury; second best is 1-7 days; worst is after 14 days.

5.
Surg Technol Int ; 35: 406-409, 2019 11 10.
Artigo em Inglês | MEDLINE | ID: mdl-31687779

RESUMO

Tantalum rod implantation with vascularized bone transplantation has been reported to be an effective method for the treatment of osteonecrosis of the femoral head (ONFH). However, long-term follow-up results were unclear. Sixty-five patients (71 hips) with ONFH treated with this technique were retrospectively reviewed. According to the Association Research Circulation Osseous (ARCO) classification, 21 hips were stage II, 30 were stage III, and 15 were stage IV. Sixty-one patients (66 hips) were followed for more than 10 years. Fifteen hips had to be converted to total hip arthroplasty (THA), the proportion of THA conversion surgery over 10 years postoperative was 4.76% for stage II, 16.7% for stage III, and 60% for stage IV, respectively. The 10-year joint-preserving success rate of the entire group was 77.2%. The Harris Hip Score (HHS) in the patients not receiving THA therapy increased from a mean of 51.35 points (ranged from 32 to 62 points) to 90.12 points (ranged from 72 to 99 points). The technique of tantalum rod implantation with vascularized bone grafting was an effective joint-preserving method for the treatment of ARCO stage II-III ONFH.


Assuntos
Transplante Ósseo , Necrose da Cabeça do Fêmur , Cabeça do Fêmur/cirurgia , Necrose da Cabeça do Fêmur/cirurgia , Seguimentos , Humanos , Estudos Retrospectivos , Análise de Sobrevida , Tantálio , Resultado do Tratamento
6.
JBJS Essent Surg Tech ; 9(2): e20, 2019 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-31579538

RESUMO

Background: The goal of a vascularized bone flap transfer is to replace the necrotic bone of the femoral head, restore the blood supply, and provide new bone and mechanical support for the femoral head. Description: The major steps of the procedure that are demonstrated in this article are: (1) using the anterolateral approach to the hip, the incision is made; (2) the interval between the rectus femoris and vastus lateralis is split, the transverse branch of the lateral femoral circumflex artery is identified, and the pedicle is isolated and protected; (3) the vascularized bone flap is harvested from the greater trochanter; (4) necrotic bone is debrided through a bone window made at the junction of the femoral neck and head; (5) the cancellous bone from the greater trochanter is implanted, and the vascularized bone flap is positioned and fixed; and (6) the wound is closed in layers. Complications are rare, and full weight-bearing is allowed after 3 months postoperatively. Alternatives: Free vascularized fibular graft. Rationale: Compared with a free vascularized fibular grafting technique, vascularized bone-grafting of the greater trochanter has the advantages of being less invasive, incurring lower donor-site morbidity, and not requiring any microsurgical technique because there is no vascular anastomosis.

7.
Graefes Arch Clin Exp Ophthalmol ; 257(12): 2613-2621, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31529324

RESUMO

PURPOSE: To evaluate the edema reduction after intravitreal injection of ranibizumab (IVR) in two diabetic macular edema (DME) components in the same eye using optical coherence tomography (OCT). METHODS: Totally 113 eyes with mixed OCT pattern of DME were included. All the eyes underwent best-corrected visual acuity (BCVA) examination and OCT scanning at baseline and follow-up visits (1, 3, and 6 months after 3 monthly consecutive IVR). The mixed OCT pattern of DME was classified into 2 OCT components: serous retinal detachment (SRD) component and non-SRD component. Foveal thickness of the SRD component (SRDFT) and the non-SRD component (NSRDFT) was compared between baseline and follow-up visits. Reduction and reduction ratio of the SRDFT and the NSRDFT at each follow-up were compared. When calculating the NSRDFT reduction ratio, we innovatively optimized a commonly used formula by subtracting the normal foveal thickness from the baseline NSRDFT. RESULTS: SRDFT was 265.6 ± 175.4 µm at baseline and was significantly decreased to 126.7 ± 114.4 µm at 1 month, to 110.5 ± 103.4 µm at 3 months, and to 110.4 ± 89.6 µm at 6 months (all P < 0.001). NSRDFT was 409.5 ± 173.1 µm at baseline and was significantly decreased to 274.1 ± 140.4 µm at 1 month, to 249.1 ± 95.9 µm at 3 months, and to 254.1 ± 90.4 µm at 6 months (all P < 0.001). There was no significant difference in reduction or reduction ratio between NSRDFT and SRDFT during follow-up (all P > 0.05). The correlation between BCVA and SRDFT was most significant at baseline (r = 0.366, P < 0.001) and the correlation between BCVA and NSRDFT was most significant at 6 months (r = 0.426, P < 0.001). BCVA improvement was more significantly correlated with reduction or reduction ratio of SRDFT at each follow-up timepoint (r = 0.271-0.426, all P < 0.01). CONCLUSIONS: IVR was effective in reducing both the SRD and non-SRD components of DME according to our optimized formula. The association between BCVA improvement and edema reduction was more significant in the SRD component.

8.
Thorac Cancer ; 10(10): 1868-1878, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31486270

RESUMO

BACKGROUND: The aim of this study was to investigate the feasibility of using a combination of apatinib in the treatment of non-small cell lung cancer. Apatinib is a tyrosine kinase inhibitor which selectivelyacts on vascular endothelial growth factor receptor 2 (VEGFR-2) and has shown good efficacy in a variety of malignancies, but the drug resistance is fast in single drug therapy. METHODS: The inhibitory effect of apatinib and other drugs on lung cancer cells was determined by CCK-8 test in vitro, and the IC50 value was determined. To establish a nude mouse xenograft model, observe the inhibitory effect of apatinib combined with other drugs on lung cancer xenografts in nude mice; immunohistochemical staining of tumor microvessel density and Ki67 expression in transplanted tumor tissues; Western blot analysis of related signaling pathways expression; immunohistochemistry was used to detect tumor microvessel density in other organs and to observe its safety. RESULTS: In this study, we found apatinib combined with pemetrexed, the first and third generation of epidermal growth factor receptor tyrosine kinase inhibitor, could synergistically inhibit the proliferation of non-small cell lung cancer cell (NSCLC) lines, reduce the microvessel density and Ki67 protein levels of three non-small cell lung cancer xenografts, and enhance anti-tumor activity by synergistically inhibiting the MAPK-ERK and PI3K-AKT-mTOR signaling pathway. Furthermore, there were no pathological abnormalities in the heart, brain, liver and kidney of each group. CONCLUSIONS: The efficacy of apatinib combination is better than that of monotherapy, and there is no significant difference in toxicity of important organs, which suggests the feasibility of a combination of apatinib in the treatment of non-small cell lung cancer.

9.
Mol Immunol ; 114: 243-250, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31394381

RESUMO

Age-related macular degeneration (AMD) is the most common cause of vision loss in the aged population. Aging and inflammation are thought to promote AMD pathogenesis in people with genetic predisposition. Follicular helper T (Tfh) cells play critical roles in inflammatory responses. Here, we investigated circulating Tfh cells in AMD patients. Circulating Tfh cells were defined as CXCR5+ CD4 T cells. Data showed that patients with the wet-type AMD presented significantly higher levels of Tfh cells than non-AMD controls. Interestingly, the Tfh cells from dry and wet AMD patients also presented significantly higher ICOS and PD-1 expression, together with higher IL-17 and IL-21 expression directly ex vivo and following PMA/ionomycin stimulation. The expression of IFNg and IL-10, on the other hand, was not different between Tfh cells from AMD patients and their counterparts in non-AMD controls. Functional analysis revealed that Tfh cells from AMD patients were better at inducing the production of IgG and IgA, and this effect was in an IL-21-dependent manner. Together, we demonstrated that the circulating Tfh cell responses were dysregulated in AMD patients.


Assuntos
Interleucinas/imunologia , Degeneração Macular/imunologia , Linfócitos T Auxiliares-Indutores/imunologia , Idoso , Linfócitos T CD4-Positivos/imunologia , Técnicas de Cocultura/métodos , Citocinas/imunologia , Feminino , Humanos , Imunoglobulina A/imunologia , Imunoglobulina G/imunologia , Interferon gama/imunologia , Interleucina-10/imunologia , Masculino , Pessoa de Meia-Idade
10.
JBJS Essent Surg Tech ; 9(1): e5, 2019 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-31086723

RESUMO

Background: Osteonecrosis of the femoral head often affects young active adults and leads to destruction of the hip joint and severe arthritis1-4. Despite improvements in hip arthroplasty design and techniques, it is unlikely that prosthetic replacements will endure for life. Alternatively, various head-preserving procedures have been used to avert or delay the need for a total hip arthroplasty5-11. Vascularized iliac bone flap transfer is a joint-preserving procedure that can be considered for younger patients with early or middle-stage osteonecrosis of the femoral head. Description: The major steps of the procedure include (1) an anterior approach to the affected hip, (2) creation of a bone flap from the iliac crest pedicled with the ascending branch of the lateral circumflex femoral artery, (3) obtaining cancellous bone from the iliac crest, (4) exposure of the anterior aspect of the femoral neck, (5) creation of a 2 × 2-cm window at the junction of the femoral head and neck, (6) debridement and removal of the necrotic bone, (7) implantation of the cancellous bone and vascularized bone flap, (8) fixation of the bone flap, and (9) layer-by-layer wound closure. Complications are rare, and full weight-bearing is allowed at 6 months postoperatively. Alternatives: Alternatives to the procedure include core decompression, nonvascularized bone-grafting, free vascularized fibular grafting, and vascularized greater trochanter grafting. Rationale: Various femoral head-preserving procedures have been reported. Core decompression is an effective femoral head-preserving procedure and is recommended as the first surgical treatment option for symptomatic small to medium-sized precollapse lesions. However, outcomes are poor when a patient has a large lesion or femoral head collapse. The advantage of vascularized iliac bone flap transfer is that it allows femoral head decompression, restores blood supply, and provides structural support. Thus, this procedure can be performed in patients with later osteonecrosis stages before hip osteoarthritis has progressed.

11.
Stem Cell Res Ther ; 10(1): 72, 2019 03 05.
Artigo em Inglês | MEDLINE | ID: mdl-30837004

RESUMO

BACKGROUND: The body is unable to repair and regenerate large area bone defects. Moreover, the repair capacity of articular cartilage is very limited. There has long been a lack of effective treatments for osteochondral lesions. The engineered tissue with biphase synthetic for osteochondral repair has become one of the hot research fields over the past few years. In this study, an integrated biomanufacturing platform was constructed with bone marrow mesenchymal stem cells (BMSCs)/porous tantalum (pTa) associated with chondrocytes/collagen membranes (CM) to repair large osteochondral defects in load-bearing areas of goats. METHODS: Twenty-four goats with a large osteochondral defect in the femoral heads of the left hind legs were randomly divided into three groups: eight were treated with chondrocytes/CM-BMSCs/pTa, eight were treated with pure CM-pTa composite, and the other eight goats were untreated. The repair effect was assessed by X-ray, gross observation, and histomorphology for 16 weeks after the operation. In addition, the biocompatibility of chondrocytes/CM-BMSCs/pTa was observed by flow cytometry, CCK8, immunocytochemistry, and Q-PCR. The characteristics of the chondrocytes/CM-BMSCs/pTa were evaluated using both scanning electron microscopy and mechanical testing machine. RESULTS: The integrated repair material consists of pTa, injectable fibrin sealant, and CM promoted adhesion and growth of BMSCs and chondrocytes. pTa played an important role in promoting the differentiation of BMSCs into osteoblasts. Three-dimensional CM maintained the phenotype of chondrocytes successfully and expressed chondrogenic genes highly. The in vivo study showed that after 16 weeks from implantation, osteochondral defects in almost half of the femoral heads had been successfully repaired by BMSC-loaded pTa associated with biomimetic 3D collagen-based scaffold. CONCLUSIONS: The chondrocytes/CM-BMSCs/pTa demonstrated significant therapeutic efficacy in goat models of large osteochondral defect. This provides a novel therapeutic strategy for large osteochondral lesions in load-bearing areas caused by severe injury, necrosis, infection, degeneration, and tumor resection with a high profile of safety, effectiveness, and simplicity.

12.
Mol Med Rep ; 19(5): 3505-3518, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30896852

RESUMO

Transforming growth factor ß1 (TGF­ß1) has been suggested to be a candidate cytokine in the field of bone tissue engineering. Cytokines serve important roles in tissue engineering, particularly in the repair of bone damage; however, the underlying molecular mechanisms remain unclear. In the present study, the effects of TGF­ß1 on the osteogenesis and motility of hFOB1.19 human osteoblasts were demonstrated via the phenotype and gene expression of cells. Additionally, the role of the phosphatidylinositol 3­kinase/protein kinase B/mammalian target of rapamycin/S6 kinase 1 (PI3K/AKT/mTOR/S6K1) signalling pathway in the effects of TGF­ß1 on osteoblasts was investigated. It was demonstrated using Cell Counting Kit­8 and flow cytometry assays that the proliferation of human osteoblasts was promoted by 1 ng/ml TGF­ß1. In addition, alkaline phosphatase activity, Alizarin red staining, scratch­wound and Transwell assays were conducted. It was revealed that osteogenesis and the migration of cells were regulated by TGF­ß1 via the upregulation of osteogenic and migration­associated genes. Alterations in the expression of osteogenesis­ and migration­associated genes were evaluated following pre­treatment with a PI3K/AKT inhibitor (LY294002) and an mTOR/S6K1 inhibitor (rapamycin), with or without TGF­ß1. The results indicated that TGF­ß1 affected the osteogenesis and mineralisation of osteoblasts via the PI3K/AKT signalling pathway. Furthermore, TGF­ß1 exhibited effects on mTOR/S6K1 downstream of PI3K/AKT. The present study demonstrated that TGF­ß1 promoted the proliferation, differentiation and migration of human hFOB1.19 osteoblasts, and revealed that TGF­ß1 affected the biological activity of osteoblasts via the PI3K/AKT/mTOR/S6K1 signalling pathway. Our findings may provide novel insight to aid the development of bone tissue engineering methods for the treatment of bone injury.


Assuntos
Osteoblastos/metabolismo , Fosfatidilinositol 3-Quinases/metabolismo , Proteínas Proto-Oncogênicas c-akt/metabolismo , Proteínas Quinases S6 Ribossômicas 70-kDa/metabolismo , Transdução de Sinais , Fator de Crescimento Transformador beta1/metabolismo , Linhagem Celular , Movimento Celular , Proliferação de Células , Humanos , Modelos Biológicos , Osteogênese , Serina-Treonina Quinases TOR
13.
Mater Sci Eng C Mater Biol Appl ; 99: 1123-1132, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30889646

RESUMO

Osteonecrosis of the femoral head (ONFH) results in collapse of the femoral head and rapid destruction of the hip joint. The repair of post-collapse articular cartilage and subchondral bone is challenging. We interrupted the blood supply to the femoral head and established a full-thickness articular defect animal model after ONFH was determined via X-ray. Porous tantalum and a Bio-Gide collagen membrane, co-cultured with bone marrow mesenchymal stem cells (BMSCs) in vitro, were implanted into the defect zone to repair the full-thickness articular defect. Hyaline cartilage was detected on top of the tantalum near the edge of the defect 12 weeks post-operatively. Porous tantalum and a Bio-Gide collagen membrane with BMSCs may repair full-thickness articular defects if the blood supply can be reconstructed in the post-collapse stage of ONFH.


Assuntos
Cartilagem Articular/patologia , Colágeno/farmacologia , Necrose da Cabeça do Fêmur/terapia , Membranas Artificiais , Células-Tronco Mesenquimais/citologia , Tantálio/farmacologia , Animais , Diferenciação Celular/efeitos dos fármacos , Proliferação de Células/efeitos dos fármacos , Células Cultivadas , Condrócitos/citologia , Condrócitos/efeitos dos fármacos , Condrogênese/efeitos dos fármacos , Técnicas de Cocultura , Necrose da Cabeça do Fêmur/patologia , Células-Tronco Mesenquimais/efeitos dos fármacos , Células-Tronco Mesenquimais/ultraestrutura , Osteogênese/efeitos dos fármacos , Fenótipo , Coelhos
14.
Orthop Surg ; 11(2): 325-329, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30884151

RESUMO

Fractures of the tibia represent a common class of injuries in orthopedics. The blood supply to the tibia is poor due to the small subcutaneous muscle tissues inside. Consequently, the tibia is prone to delayed fracture healing and nonunion of the fracture after surgery. In this case, we used porous tantalum metal plate to treat nonunion of a tibial fracture and achieved satisfactory therapeutic effects. For the first time in the field, we used 3D printing technology to fabricate porous tantalum metal plates for the treatment of tibial fractures. The resulting porous tantalum metal exhibited excellent mechanical and biological properties, and improved the therapeutic effects for the treatment of a tibial fracture nonunion. Porous tantalum metal plates have great application potential as a new implant material for internal fixation.


Assuntos
Materiais Biocompatíveis , Placas Ósseas , Tantálio , Fraturas da Tíbia/cirurgia , Adulto , Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/métodos , Consolidação da Fratura , Humanos , Masculino , Impressão Tridimensional , Radiografia , Fraturas da Tíbia/diagnóstico por imagem
15.
Br J Ophthalmol ; 103(12): 1747-1752, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30674454

RESUMO

AIMS: To investigate the function and the corresponding neurovascular structures in patients with diabetes without clinically detectable retinopathy. METHODS : Sixty-six patients with type 2 diabetes without retinopathy (NDR) and 62 healthy controls were recruited. The 16 and 32 Tds flicker electroretinography (ERG) was performed using a mydriasis-free, full-field flicker ERG recording device (RETeval). The vessel density (VD) of superficial capillary plexus (SCP) and deep capillary plexus (DCP), FD300 and ganglion cell complex (GCC) thickness in the macula were quantified using optical coherence tomography angiography (OCTA). The retinal nerve fibre layer (RNFL) thickness and the radial peripapillary capillary (RPC) density in the peripapillary area were also measured with OCTA. RESULTS: Parafoveal and perifoveal VD in both SCP and DCP decreased in NDR group in comparison to control group (all p<0.01). However, macular GCC thickness was comparable between the two groups (p=0.661). Peripapillary RNFL thickness and RPC density were significantly lower in NDR group (p<0.001 and p=0.009, respectively). With regard to ERG parameters, delayed implicit time and decreased amplitude were found in NDR group in comparison to the control group (all p<0.01). In the multiple linear regression analyses, delayed implicit time for 16 and 32 Tds stimuli was significantly correlated with increased HbA1c (ß=0.350, p<0.001; ß=0.328, p<0.001, respectively) and decreased VD of SCP in the parafoveal region (ß=-0.266, p=0.013; ß=-0.253, p=0.005, respectively). However, delayed implicit time for 16 and 32 Tds stimuli was not correlated with the thickness of GCC (ß=-0.008, p=0.818) in multiple linear regression analyses. CONCLUSION: Functional and structural impairments have already started in diabetic retina even in the absence of visible retinal lesions. Subtle microvascular abnormalities rather than ganglion cell loss might be associated with early functional changes in NDR patients. Poor control of blood glucose was associated with delayed implicit time of flicker ERG in preclinical diabetic retinopathy.

16.
Int Orthop ; 43(5): 1083-1087, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-29876626

RESUMO

OBJECTIVE: This study aims to investigate the early diagnosis and treatment of steroid-induced osteonecrosis of the femoral head. PATIENTS AND METHODS: From January 2010 to January 2014, a total of 350 patients, who required the use of large amounts of hormones, were enrolled into the study. These patients were followed up every three months after starting the hormone therapy. A total of 62 cases were screened, among which nine cases were asymptomatic. Furthermore, 38 patients were diagnosed as stage I and were given low-molecular weight heparin (LMWH) and vasodilator drugs. Moreover, 22 cases were diagnosed as stage IIa/b and underwent core decompression. In addition, two cases were diagnosed as stage IIc and underwent pedicled bone transplantation. During the follow-up period, ARCO staging was used for radiological evaluation, the HHS score was applied to evaluate for clinical efficacy, and SPSS 22.0 statistical software was used for the data analysis. RESULTS: A total of 60 patients were followed up for 24 months. Among these patients, 38 patients were diagnosed with ARCO stage I and underwent systematic therapy. No progress was found in 29 cases (76.3%). Furthermore, three cases progressed to stage IIb (7.8%), four cases progressed to stage IIc (10.5%), two cases progressed to stage III and IV, respectively (2.6%), and 16 cases (80%) did not progress after core decompression. In the 16 cases at stage IIa and four cases at stage IIb, and four cases (20%) progressed in stage III. The HHS score of stage I was 80.42 ± 3.25 before follow-up, while the HHS score was 86.46 ± 8.54 after follow-up, and the difference was statistically significant (P < 0.05). Furthermore, the HHS score of patients with stage IIa/b was 70.38 ± 4.62 before follow-up, while the HHS score was 80.28 ± 6.72 after follow-up, and the difference was statistically significant (P < 0.01). CONCLUSION: MRI remains as the most effective method for the non-invasive diagnosis of osteonecrosis, at present. Enhanced MRI may be able to detect early osteonecrosis, but further research is needed. Drug treatment and core decompression can achieve satisfactory results at the early stage.


Assuntos
Necrose da Cabeça do Fêmur/diagnóstico por imagem , Necrose da Cabeça do Fêmur/terapia , Cabeça do Fêmur/cirurgia , Adolescente , Adulto , Angiografia Digital , Anticoagulantes/administração & dosagem , Transplante Ósseo , Descompressão Cirúrgica , Diagnóstico Precoce , Feminino , Cabeça do Fêmur/efeitos dos fármacos , Necrose da Cabeça do Fêmur/induzido quimicamente , Necrose da Cabeça do Fêmur/classificação , Seguimentos , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Vasodilatadores , Adulto Jovem
17.
Int J Biol Macromol ; 116: 106-112, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29729342

RESUMO

The present study aimed to investigate the effects of a purified polysaccharide (SPS) from the safflower in a cellular model of steroid-associated necrosis of the femoral head (SANFH), which was established in primary murine osteoblasts suffering dexamethasone pretreatment. After treatment with SPS (25, 50 and 100 µg/ml), the degree of necrosis induced by dexamethasone was significantly reduced in osteoblasts as evidenced by an increase of cell viability and a decrease of apoptosis in osteoblasts. Furthermore, pretreatment with SPS (25, 50 and 100 µg/ml) significantly attenuated the activation of caspase-3 and cleavage of PARP relative to the model control cells. The addition of caspase-3 inhibitor (Z-DEVD-FMK) in dexamethasone-treated osteoblasts resulted in the inefficiency of SPS for inhibiting cellular apoptosis. Dose-dependent increases in alkaline phosphatase (ALP) activity, collagen synthesis and mineralization were also observed in SPS-treated osteoblasts at 72 h. The present study demonstrates that SPS may alleviate dexamethasone associated osteonecrosis by inhibiting caspsae-3-mediated apoptosis and may provide an alternative treatment for SANFH.


Assuntos
Apoptose/efeitos dos fármacos , Carthamus tinctorius/metabolismo , Caspase 3/metabolismo , Necrose da Cabeça do Fêmur/tratamento farmacológico , Polissacarídeos/farmacologia , Animais , Proteínas Reguladoras de Apoptose/metabolismo , Sobrevivência Celular/efeitos dos fármacos , Dexametasona/farmacologia , Necrose da Cabeça do Fêmur/induzido quimicamente , Necrose da Cabeça do Fêmur/metabolismo , Camundongos , Osteoblastos/efeitos dos fármacos , Ratos , Ratos Wistar , Transdução de Sinais/efeitos dos fármacos , Esteroides/farmacologia
18.
Orthop Surg ; 10(1): 69-74, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29424129

RESUMO

The present study investigates the feasibility of micro perfusion of femoral head specimens from femoral neck fracture patients by the inferior retinacular arteries and performing intraosseous artery quantitative analysis of the femoral head. Twelve femoral neck fracture patients who had undergone conventional hip replacement surgery were included in this study. Femoral head specimen arteries were first dissected and exposed and then perfused by the inferior retinacular arteries and all the femoral heads underwent micro-CT scanning. After micro-CT scanning, a digital 3-D model was reconstructed to quantify the femoral head intraosseous arteries for comparison with a normal femoral head. The artery length density, artery volume density, and artery length/volume ratio were calculated separately and compared with normal femoral head parameters. Micro-CT scanning displayed the epiphyseal arterial network structure and their fine vascular branches in all 12 femoral neck fractures. Blood was supplied from the inferior retinacular artery to the epiphyseal arterial network then to all the fine blood vessels within the femoral head. No statistical differences were observed in femoral heads' intraosseous artery length densities or volume densities between the normal and femoral neck fracture specimens, while the artery length/volume ratio showed a statistical difference, and the ratio increased from 19 to 46. Micro perfusion of the femoral head by the inferior retinacular arteries is possible and can present the epiphyseal network and their fine arterial branches in pathologic conditions to provide a morphological basis for the study of femoral head disease.


Assuntos
Fraturas do Colo Femoral/patologia , Cabeça do Fêmur/irrigação sanguínea , Adulto , Idoso , Idoso de 80 Anos ou mais , Artérias/diagnóstico por imagem , Artérias/patologia , Artroplastia de Quadril , Meios de Contraste , Estudos de Viabilidade , Feminino , Fraturas do Colo Femoral/diagnóstico por imagem , Cabeça do Fêmur/diagnóstico por imagem , Humanos , Imagem Tridimensional/métodos , Masculino , Pessoa de Meia-Idade , Microtomografia por Raio-X
19.
Microsurgery ; 38(8): 882-888, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29214678

RESUMO

PURPOSE: We present the results of a study on the anatomy of the ascending branch of the lateral circumflex femoral artery (AB-LCFA) and the use of the pedicled iliac bone flap transfer perfused by AB-LCFA combined with external fixation for the treatment of the nonunion of upper femoral shaft fractures. METHODS: The orientation, diameter, length, and distribution of the AB-LCFA from 40 lower limbs of adult cadavers were dissected and measured. From 2000 to 2012, 13 patients with nonunion of upper femoral shaft fractures underwent pedicled iliac bone flap transfer perfused by the AB-LCFA combined with external fixation. The time of bone fracture union was recorded based on X-ray examination. The functional results of the femoral shaft were evaluated by the Klemm classification. RESULTS: The lateral circumflex femoral artery (LCFA) divided into ascending, transverse, and descending branches in 32 specimens (80%). The diameter of the AB-LCFA at the origin was 3.15 ± 0.9 mm and the length of the AB-LCFA was 8.51 ± 3.06 cm. The postoperative course of the procedure was uneventful in all 13 patients. The average follow-up was 15 months. Bone union was achieved in all patients and the average union time was 5.3 months. 12 patients achieved excellent or good functional results based on the Klemm classification. CONCLUSION: The AB-LCFA has a consistent orientation and abundant blood flow. The transfer of the iliac crest bone flap perfused by the AB-LCFA while combined with external fixation could be an option for treating the nonunion of upper femoral shaft fractures.


Assuntos
Fraturas do Fêmur/cirurgia , Fixação de Fratura/métodos , Fraturas não Consolidadas/cirurgia , Ílio/transplante , Retalhos Cirúrgicos , Adulto , Cadáver , Fixadores Externos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
20.
Acta Biomater ; 63: 369-382, 2017 11.
Artigo em Inglês | MEDLINE | ID: mdl-28882757

RESUMO

Mg-based alloys, as the potential orthopaedic implant, can self-degrade to avoid second operation for its remove, and enable to promote bone repair; however, the underlying molecular mechanisms remain unclear. In the present study, we examined the effect of Mg ions on osteogenesis, chemotaxis and anti-alkaline stress in hFOB1.19 human osteoblast cells to simulate bone-repairing effect of a biodegradable Mg-based alloy implant in vitro, and explored the regulatory role of the transient receptor potential melastatin 7 (TRPM7)/phosphoinositide 3-kinase (PI3K) signalling pathway in the process of Mg ion-induced bone repair by knockdown of TRPM7 and antagonizing PI3K activity. Results indicate that Mg ions up-regulated the expression of Runx2 and alkaline phosphatase (ALP) through TRPM7/PI3K signalling pathway, which could significantly enhance the osteogenic activity of human osteoblasts. Furthermore, the expression levels of MMP2, MMP9 and vascular endothelial growth factor (VEGF) were increased by TRPM7/PI3K signalling pathway, which recruits osteoblasts from low- to high-Mg ion environments by inducing cell migration. Although an alkaline environment has antibacterial effects, alkaline stress can cause cytotoxicity and induce cell death. Finally, we found that Mg ions could activate PI3K phosphorylation to promote cell growth and survival, protecting cells against the alkaline-stress-induced cytotoxicity caused by the degradation of Mg-based alloy implants. Our study not only revealed the molecular mechanism of Mg in promoting bone repair but also explained the protective effects of Mg ions on osteoblasts in an alkaline environment, which provides a theoretical basis and new directions for the application of Mg-based alloy implant material in orthopaedics fixations and osteosarcoma treatment. STATEMENTS OF SIGNIFICANCE: As a potential biomaterial for orthopaedic implant, biodegradable magnesium has several advantages including self-degradation and bone repair promotion; however, the underlying mechanisms and effective concentration by which molecular regulates the bone repair remain unclear. The present study revealed that Mg ion and its effective concentration for activating PI3K phosphorylation via TRPM7, which causes three processes affecting bone repair, namely, osteoblast recruitment, osteogenesis and resistance to alkaline stress in human osteoblast. Therefore, our results have provided insight into the underlying molecular biological basis, and guidance for manipulating degradation rate, such as surface modification, of orthopaedic Mg-based implants.


Assuntos
Ligas/farmacologia , Magnésio/farmacologia , Osseointegração/efeitos dos fármacos , Osteoblastos/metabolismo , Fosfatidilinositol 3-Quinases/metabolismo , Próteses e Implantes , Proteínas Serina-Treonina Quinases/metabolismo , Transdução de Sinais , Canais de Cátion TRPM/metabolismo , Fosfatase Alcalina/metabolismo , Calcificação Fisiológica/efeitos dos fármacos , Morte Celular/efeitos dos fármacos , Linhagem Celular , Movimento Celular/efeitos dos fármacos , Sobrevivência Celular/efeitos dos fármacos , Regulação da Expressão Gênica/efeitos dos fármacos , Técnicas de Silenciamento de Genes , Humanos , Concentração de Íons de Hidrogênio , Íons , Modelos Biológicos , Osteoblastos/efeitos dos fármacos , Osteoblastos/enzimologia , RNA Interferente Pequeno/metabolismo , Transdução de Sinais/efeitos dos fármacos , Estresse Fisiológico
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA