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1.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(4): 518-523, 2020 Apr 15.
Artigo em Chinês | MEDLINE | ID: mdl-32291992

RESUMO

Objective: To review the current research on the diagnosis and treatment of Haglund syndrome. Methods: The domestic and foreign literature about Haglund syndrome in recent years was extensively reviewed to summarize and analyze the etiology, anatomy, clinical manifestations, diagnosis, and treatment of Haglund syndrome. Results: The etiology of Haglund syndrome is not very clear, and it may be related to local friction and high gastrocnemius muscle tension, and there may be a certain genetic tendency. The local anatomy is more complex and there are many adjacent tissue structures. Haglund malformation may cause the impingement of the posterior heel bursa and Achilles tendon insertion, lead to wear of the posterior heel bursa and the Achilles tendon insertion, and finally result in pain. The FPA (Fowler-Philipp angle), CPA (calcaneal pith angle), PPL (parallel pitch lines), CLA (Chauveaux-Liet angle), and X/Y ratios (ratio of total calcaneal length to calcaneal tuberosity length) measured on X-ray film can be used for the diagnostic measurement of Haglund malformation. Treatment includes conservative and surgical treatment (open Haglund ostectomy, dorsal closed wedge osteotomy of the calcaneus, and arthroscopic Haglund osteotomy). Conclusion: Both open and arthroscopic Haglund ostectomy and dorsal closed wedge osteotomy of the calcaneus can achieve satisfactory results, but minimally invasive treatment is the current development trend. Surgeons should pay attention to the management of the calcification of Achilles tendon insertion and reconstruction of Achilles tendon insertion.

3.
Injury ; 51(4): 804-811, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32115209

RESUMO

INTRODUCTION: The association between sarcopenia and risk of fracture remained controversial. This systematic review and meta-analysis was conducted to evaluate the association between sarcopenia and fracture incidence in the middle-aged and elderly people. MATERIALS AND METHODS: Web of Science, PubMed, EMBASE, and the Cochrane Library were searched. Weighted averages were reported as hazard risk (HR) values with 95% confidence interval (CI). Statistical heterogeneity scores were assessed with the standard Cochran's Q test and the I2 statistic. RESULTS: A total of 5 cohort studies involving 27 990 participants were included in our study. The crude and adjusted effect sizes between sarcopenia and fracture were extracted from 2 and 5 studies, respectively. Sarcopenia was significantly associated with fracture incidence without adjusting covariates (crude HR, 1.69; 95% CI, 1.34-2.13). After adjusting for potential confounders, sarcopenia still demonstrated significant positive association with fracture (adjusted HR, 1.50;95%CI, 1.08-2.08). The sensitivity analysis confirmed the stability of the results. In the subgroup analysis of studies after adjusting covariates, there were significant associations between sarcopenia and fracture in the subgroups of male, older people, American and hip fracture patients. CONCLUSION: Our meta-analysis found that sarcopenia was significantly associated with fracture in middle aged and elderly people. However, more homogeneous studies are needed to fully clarify the relationship between sarcopenia and fracture.

4.
Biochem Biophys Res Commun ; 524(4): 883-889, 2020 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-32057365

RESUMO

Disuse osteoporosis (DOP) is a common complication resulting from the lack of or disuse of mechanical loading and has been unsatisfactorily treated. We hypothesized that exosomes derived from human umbilical cord mesenchymal stem cells (HUCMSCs) could reduce bone marrow mesenchymal stem cell (BMSC) apoptosis in rat DOP via the miR-1263/Mob1/Hippo signaling pathway. To evaluate the function of exosomes derived from HUCMSCs (HUCMSC-Exos) in DOP, hind limb unloading (HLU)-induced DOP rat models were prepared. In vitro, the proliferation of BMSCs were evaluated using CCK-8 assays. Further, the apoptosis of BMSCs were evaluated using annexin V-FITC assay and Western blots. In vivo, the protective effects of HUCMSC-Exos were evaluated using HE staining and microCT analysis. The underlying molecular mechanism of exosome action on BMSC apoptosis through the miR-1263/Mob1/Hippo pathway was also investigated by high-throughput RNA sequencing, luciferase reporter assays, RNA-pull down assays and Western blots. The RNA-seq and q-PCR results showed that the level of miR-1263 was most abundant among differentially expressed microRNAs. Exosomal miR-1263 could bind to the 3'untranslated region (3' UTR) of Mob1 and exert its function by directly targeting Mob1 in recipient cells. The inhibition of Mob1 could activate YAP expression. Hippo inhibition reversed the in vitro HLU-induced apoptotic effect on BMSCs. The microCT and HE staining results indicated that HUCMSC-Exos ameliorated DOP in vivo. Exosomes derived from HUCMSCs are effective at inhibiting BMSC apoptosis and preventing rat DOP. This mechanism is mediated by the miR-1263/Mob1/Hippo signaling pathway.

5.
J Orthop Surg Res ; 15(1): 45, 2020 Feb 11.
Artigo em Inglês | MEDLINE | ID: mdl-32046746

RESUMO

BACKGROUND: Current there are different screws fixation methods used for fixation of the talar neck fracture. However, the best method of screws internal fixation is still controversial. Few relevant studies have focused on this issue, especially by finite element analysis. The purpose of this study was to explore the mechanical stability of dual screws internal fixation methods with different approaches and the best biomechanical environment of the fracture section, so as to provide reliable mechanical evidence for the selection of clinical internal fixation. METHODS: The computed tomography (CT) image of the healthy adult male ankle joint was used for three-dimensional reconstruction of the ankle model. Talus neck fracture and screws were constructed by computer-aided design (CAD). Then, 3D model of talar neck fracture which fixed with antero-posterior (AP) parallel dual screws, antero-posterior (AP) cross dual screws, postero-anterior (PA) parallel dual screws, and postero-anterior (PA) cross dual screws were simulated. Finally, under the condition of 2400N vertical load, finite element analysis (FEA) were carried out to compare the outcome of the four different internal fixation methods. The results of Von Mises stress, displacement of four groups which contain talus fracture fragments and screws internal fixations were analyzed. RESULTS: Compared with the other three groups, postero-anterior (PA) parallel dual screws had better results in the stress peak, stress distribution, and displacement of talus and internal fixation. CONCLUSIONS: To sum up, the Von Mises stress of fracture section was the smallest, the stress distribution of screws were the most scattered, and the peak value was the smallest in posterior to anterior parallel double screws fixation, which was obviously better than that in the other three groups. When using screws internal fixation, the method of posterior to anterior screws fixation is better than that of anterior to posterior screws fixation, and the peak value and stress distribution of parallel double screws fixation is better than that of cross double screws fixation. Thus, for the talar neck fracture, the use of posterior to anterior parallel double screws fixation is recommended in clinical surgery.

6.
Clin Spine Surg ; 33(2): E63-E70, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32102051

RESUMO

STUDY DESIGN: A minimally invasive surgical technique for lumbar spondylolisthesis. OBJECTIVE: The objective of this study was to investigate the feasibility and clinical efficacy of interbody fusion and percutaneous reduction for lumbar spondylolisthesis using mobile microendoscopic discectomy (MMED) technique. SUMMARY OF BACKGROUND DATA: Current surgical techniques for lumbar spondylolisthesis cause considerable trauma, so a minimally invasive technique is needed. MATERIALS AND METHODS: A total of 62 patients of lumbar spondylolisthesis (40 patients of degenerative spondylolisthesis and 22 patients of isthmic spondylolisthesis) were treated with interbody fusion and percutaneous reduction using the MMED technique. A 2.5-cm longitudinal incision was made on the side of dominant symptoms, with paraspinous approach used for degenerative spondylolisthesis and transforaminal approach for isthmic spondylolisthesis. The fenestration and decompression were performed under MMED. The intervertebral space was released through an outer tube under direct vision, followed by bone graft and cage implantation. Percutaneous pedicle screws were used, with the residual spondylolisthesis further reduced. The patients were followed up to evaluate the clinical results. RESULTS: The procedure was successful in all patients. Postoperative radiographs showed sufficient decompression and improvement of spinal alignment for both groups. The average reduction rate of the spondylolisthesis was 68% for degenerative spondylolisthesis group and 66% for isthmic spondylolisthesis group. The patients of 2 groups were followed up for 12-24 months. At the final follow-up, the Oswestry Disability Index and Visual Analogue Scale scores decreased significantly compared with preoperation for both groups. The clinical results were excellent in 22 cases, good in 16 and fair in 2 for degenerative spondylolisthesis group, and excellent in 11 cases, good in 10 and fair in 1 for isthmic spondylolisthesis group according to the Macnab Scale. CONCLUSION: Interbody fusion and percutaneous reduction with MMED provides a minimally invasive procedure for lumbar spondylolisthesis, with sufficient decompression, reduction, fusion, and satisfactory clinical results.

7.
Arthroscopy ; 36(5): 1452-1464.e2, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31919027

RESUMO

PURPOSE: This systematic review and network meta-analysis aimed to compare the clinical outcomes between 4 intra-articular injections (platelet-rich plasma [PRP], hyaluronic acid [HA], corticosteroid [CS], and HA plus PRP) for hip osteoarthritis (OA). METHODS: We performed a systematic literature search in PubMed, Embase, Web of Science, and the Cochrane database through April 2018 to identify any randomized controlled trials that evaluated the clinical efficacy of HA, PRP, CS, HA-plus-PRP, and control treatments for hip OA. Baseline information-country, mean age, number of patients, and Kellgren-Lawrence grade of hip OA in the treatment and control groups-was collected. The primary outcome was the visual analog scale (VAS) score at 1, 3, 6, and 12 months after injection. RESULTS: We included 11 randomized controlled trials with a total of 1,060 patients. The Kellgren-Lawrence grades of the treatment and control groups were similar in individual studies. The pair-wise meta-analysis indicated that CS and HA were superior to the control group in reducing the VAS score at 1 month and 3 months (P < .05) and that CS was superior to HA in reducing the VAS score at 1 month (P < .05). The network meta-analysis results indicated that HA and CS exhibited a beneficial role in reducing the VAS score at 1 month. CS achieved the lowest value for the surface under the cumulative ranking curve (SUCRA) for the VAS score at 1 month (0.23), and the SUCRA values of the 5 interventions showed that PRP achieved the lowest SUCRA value for the VAS score at 6 months (0.53). CONCLUSIONS: CS injections are recommended as the most efficient agent in hip OA patients in the short term. Moreover, PRP is reported to have the highest rank for pain relief for up to 6 months. Considering the limitations of this meta-analysis, future direct comparisons with more samples are needed. LEVEL OF EVIDENCE: Level II, meta-analysis of Level I and II studies.

8.
Orthop Traumatol Surg Res ; 106(1): 95-101, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31345739

RESUMO

BACKGROUND: The optimal type of fixation implant for managing subtrochanteric fractures (STFs) is debated, as uncertainty continues to surround the comparative biomechanical performance of the proximal femoral nail antirotation (PFNA), proximal femoral locking plate (PFLP), and reverse less invasive stabilisation system (LISS). No studies have used finite element analysis (FEA) to compare these three devices. The objective of this study was to use FEA to compare the PFNA, PFLP, and LISS used to treat STFs based on the following criteria: (1) stress distribution on the femur and implant, (2) peak stress and stress on the medial side of the femur near the fracture site, and (3) smallest axial displacement of the femoral head. HYPOTHESIS: Of the three implants, the PFNA has the best biomechanical performance when used for STF fixation. METHODS: FEA was used to assess synthetic bone responses to the three implants used to fix three STF types, namely, Seinsheimer I, III, and IV, characterised by increasing bone loss and/or comminution with subsequent instability. Loading was with 1400N axial compression force. RESULTS: The LISS and PFLP exhibited similar biomechanical properties in all three fracture types. However, with the Seinsheimer IV fracture, the triangular configuration of the PFLP resulted in stress concentration at the medial and lateral sides of the implant junction. With the Seinsheimer I and III fractures, the PFNA resulted in higher peak stress (183.85MPa and 364.58MPa, respectively) compared to the PFLP (102.90MPa and 177.52MPa) and LISS (116.55MPa and 227.97MPa). With the Seinsheimer IV fracture, peak stress was highest with LISS (2310.40MPa) and was higher with PFLP (2054.90MPa) than with PFNA (1313.30MPa). With the Seinsheimer I and III fractures, the axial femoral head displacement was greater with the PFNA (0.74mm and 1.13mm, respectively) than with the PFLP (0.48mm and 1.02mm) and LISS (0.52mm and 0.92mm). With the Seinsheimer IV fracture, in contrast, the PFNA produced less axial femoral head displacement (4.1mm) compared to the PFLP (12.03mm) and LISS (16.56mm). DISCUSSION: With unstable (Seinsheimer IV) STFs, fixation stability was better with the PFNA compared to the PFLP and LISS. In contrast, with stable STFs (Seinsheimer I and III), the PFLP and LISS offered greater stability, with similar biomechanical effects. However, with Seinsheimer III fractures, the stress on the implant-femur interface was greater with the LISS. LEVEL OF EVIDENCE: IV, basic science study.

9.
J Orthop Surg Res ; 14(1): 422, 2019 Dec 10.
Artigo em Inglês | MEDLINE | ID: mdl-31823801

RESUMO

BACKGROUND: More elderly patients are suffering from intertrochanteric fractures. However, the choice of internal fixation is still controversial, especially in the treatment of unstable intertrochanteric fracture; thus, previous implants continue to be improved, and new ones are being developed. The purpose of our study was to compare the biomechanical advantages between the zimmer natural nail (ZNN) and proximal femoral nail antirotation-II (PFNA-II) in the treatment of elderly reverse obliquity intertrochanteric fractures. METHODS: A three-dimensional finite element was applied for reverse obliquity intertrochanteric fracture models (AO31-A3.1) fixed with the ZNN or PFNA-II. The distribution, peak value and position of the von Mises stress and the displacement were the criteria for comparison between the two groups. RESULTS: The stresses of the internal fixation and femur in the ZNN model were smaller than those in the PFNA-II model, and the peak values of the two groups were 364.8 MPa and 171.8 MPa (ZNN) and 832.3 MPa and 1795.0 MPa (PFNA-II). The maximum amount of displacement of the two groups was similar, and their locations were the same, i.e., in the femoral head vertex (3.768 mm in the ZNN model and 3.713 mm in the PFNA-II model). CONCLUSIONS: The displacement in the two models was similar, but the stresses in the implant and bone were reduced with the ZNN. Therefore, the ZNN implant may provide biomechanical advantages over PFNA-II in reverse obliquity intertrochanteric fractures, as shown through the finite element analysis. These findings from our study may provide a reference for the perioperative selection of internal fixations.

10.
Int J Surg ; 72: 16-24, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31614202

RESUMO

BACKGROUND: The advantages of continuous adductor canal block (CACB) over single shot ACB (SACB) are still debatable for pain management after total knee arthroplasty (TKA). The aim of this study was to investigate which ACB method provides better pain relief after TKA. METHODS: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science were searched without any language restrictions. Only randomised clinical trials (RCTs) were included in this meta-analysis. The primary outcome was pain score, whereas the secondary outcomes included opioid consumption, post-operative complication, and length of stay. RESULTS: Eight RCTs with a total of 642 patients were included. The overall evidence for outcomes was moderate. The pooled data indicated that the use of CACB after TKA surgery was associated with lower pain score at rest or movement (P < 0.00001), cumulative morphine consumption (P = 0.003), and length of hospital stay (P = 0.03) compared with SACB, with no difference in nausea or vomiting rate (P = 0.55). CONCLUSIONS: Compared with SACB, CACB provides better analgesia after TKA. Therefore, CACB is recommended as an analgesic method for early postoperative pain treatment after TKA.

11.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 33(11): 1351-1357, 2019 Nov 15.
Artigo em Chinês | MEDLINE | ID: mdl-31650747

RESUMO

Objective: To investigate the safety and effectiveness of anatomical approach osteoligaments repair technique in treatment of pronation ankle fractures. Methods: The clinical data of 53 patients with pronation ankle fractures between April 2015 and October 2016, who were treated with anatomical approach osteoligaments repair technique applied for fracture reduction and internal fixation, were analysed retrospectively. There were 35 males and 18 females with an average age of 33.1 years (range, 18-60 years). The cause of injury included traffic accidents in 27 cases, tumbling in 5 cases, fall from height in 4 cases, twisted injury in 6 cases, sports injuries in 4 cases, and bruises in 7 cases. According to Lauge-Hansen classification, there were 44 cases of pronation external rotation stage Ⅳ and 9 cases of pronation abduction stage Ⅲ. The interval between injury and operation was 4-10 days (mean, 7 days). Postoperative pain and function of ankles were assessed by American Orthopedic Foot and Ankle Score (AOFAS) and visual analogue pain scale (VAS) score. The medial clear space (MCS), tibiofibular clear space (TFCS), distal fibular tip to lateral process of talus (DFTL), the anterior and posterior tibiofibular syndesmosis distance, and the lateral malleolus twist angle were measured by X-ray films and CT of bilateral ankle joints. Results: The tourniquet application time was 55-90 minutes (mean, 72.5 minutes); the frequency of fluoroscopy was 5-13 times (mean, 8.9 times). All incisions healed by first intention and no infection, deep vein thrombosis occurred after operation. All patients were followed up 28-48 months (mean, 36 months). There was no significant difference in postoperative MCS, TFCS, DFTL, the anterior and posterior tibiofibular syndesmosis distance, and the lateral malleolus twist angle between bilateral ankle joints ( P>0.05). At last follow-up, no ankle instability occurred and the degenerative changes of ankle joints (Kellgren-Lawrence grading Ⅱ) occurred in 5 cases. The average AOFAS score of the ankle joint was 90.84 (range, 85-95); mean VAS score was 1.23 (range, 0-5). The average dorsiflexion and plantar flexion of ankle joints was 20.24° (range, 15-25°) and 42.56° (range, 30-50°), respectively. Conclusion: Anatomical approach osteoligaments repair technique in treatment of pronation ankle fractures can expose the talocrural joint and lower tibiofibular syndesmosis clearly, repair the osteoligaments injury directly, and assist the syndesmosis and talocrural joint reduction, and decline the incidence of ankle degeneration.


Assuntos
Fraturas do Tornozelo/terapia , Adolescente , Adulto , Traumatismos do Tornozelo , Articulação do Tornozelo , Feminino , Fixação Interna de Fraturas , Fraturas Ósseas , Humanos , Masculino , Pessoa de Meia-Idade , Pronação , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
12.
Am J Transl Res ; 11(9): 5847-5857, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31632553

RESUMO

Purpose: To investigate whether mechanical load regulates LRP6 expression and whether different intensities of treadmill exercise have different effects on LRP6 expression and the biomechanical properties of hindlimb bones in Sprague-Dawley (SD) rats. Methods: Fifty-six three-month-old virgin female SD rats were randomly divided into seven groups (n=8). Each group was subjected to tail suspension, free physiological activity or different intensities of treadmill exercise according to the experimental design for four or eight weeks. Rats were sacrificed after the intervention based on experimental design, and fresh femurs, tibias and fibulas were harvested for molecular biological analysis, biomechanical testing and micro-CT analysis. Results: LRP6 expression and the Wnt/ß-catenin pathway activity decreased, and bone mass and biomechanical properties decreased after loss of mechanical stimulation. For disuse osteoporosis, even physiological activity could improve LRP6 expression, Wnt/ß-catenin pathway activity, bone mass and biomechanical properties. Compared with physiological activity, treadmill exercise had better and faster effects on bone recovery. Compared with the Low intensity Exercise Group (LE group), the Medium intensity Exercise Group (ME group) and High intensity Exercise Group (HE group) had higher LRP6 expression, bone mass and biomechanical properties, while there were no significant difference between the ME group and HE group. Conclusions: Mechanical load appears to be a regulator of LRP6 expression, and it further affects the Wnt/ß-catenin pathway activity and bone mass. The LRP6 expression, bone mass and biomechanical properties gradually improve as treadmill exercise intensity increases, while there is no significant difference between the ME group and HE group.

13.
Mol Carcinog ; 58(12): 2193-2206, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31478263

RESUMO

Protein arginine methyltransferase 1 (PRMT1) is identified as an oncogene implicated in various types of human cancers, while Yes-associated protein (YAP) as a key transcriptional coactivator of the Hippo signaling plays a vital role in tissue homeostasis and tumorigenesis. To date, the underlying biological functions, prognostic values, and potential mechanisms of PRMT1 and YAP in chondrosarcoma development have not been clearly elucidated. Here, we show that upregulation of PRMT1 and YAP is significantly detected in human chondrosarcoma specimens. Elevated levels of PRMT1 positively correlated with YAP nuclear accumulation are significantly associated with high-grade chondrosarcoma and poor prognosis. Moreover, YAP is recognized as an independent prognostic factor for chondrosarcoma patients. Ectopic expression of PRMT1 potentiates, but depletion of PRMT1 attenuates, chondrosarcoma cell growth in vitro and in vivo. Mechanistically, we have discovered that PRMT1 functions upstream of LATS1 and suppresses LATS1-mediated phosphorylation of YAP (Ser127), and thus promotes chondrosarcoma cell survival in a YAP-dependent manner. Collectively, our study identifies PRMT1 as a positive regulator of YAP activity in chondrosarcoma, highlighting a novel therapeutic target against chondrosarcoma and other YAP-driven cancers.


Assuntos
Proteínas Adaptadoras de Transdução de Sinal/genética , Neoplasias Ósseas/genética , Condrossarcoma/genética , Proteína-Arginina N-Metiltransferases/genética , Proteínas Repressoras/genética , Fatores de Transcrição/genética , Ensaios Antitumorais Modelo de Xenoenxerto/métodos , Proteínas Adaptadoras de Transdução de Sinal/metabolismo , Adulto , Animais , Neoplasias Ósseas/metabolismo , Neoplasias Ósseas/terapia , Proliferação de Células/genética , Condrossarcoma/metabolismo , Condrossarcoma/terapia , Feminino , Humanos , Masculino , Camundongos Endogâmicos BALB C , Camundongos Nus , Proteína-Arginina N-Metiltransferases/metabolismo , Interferência de RNA , Terapêutica com RNAi/métodos , Proteínas Repressoras/metabolismo , Fatores de Transcrição/metabolismo
14.
Int J Biol Sci ; 15(9): 1861-1871, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31523188

RESUMO

Purpose: Glucocorticoid-induced osteonecrosis of the femoral head (GIONFH) is a common disease after long-term or high-dose glucocorticoid use. The pathogenesis of GIONFH is still controversial, and abnormal bone metabolism caused by glucocorticoids may be one of the important factors. Exosomes, owing to their positive effect on bone repair, show promising therapeutic effects on bone-related diseases. In this study, we hypothesised that exosomes reduce osteocyte apoptosis in rat GIONFH via the miR-21-PTEN-AKT signalling pathway. Methods: To evaluate the effects of exosomes in GIONFH, a dexamethasone-treated or exosome-treated in vitro cell model and a methylprednisolone-treated in vivo rat model were set up. In vitro, a CCK-8 assay and 5-ethynyl-2'-deoxyuridine staining were performed to evaluate the proliferation of osteocytes. Further, a terminal deoxynucleotidyl transferase dUTP nick end labelling (TUNEL) assay, annexin V-fluorescein isothiocyanate-propidium iodide staining, and western blotting were conducted to evaluate the apoptosis of osteocytes. In vivo, we used micro-computed tomography and histological and immunohistochemical analyses to assess the effects of exosomes. Moreover, the mechanism of exosome action on osteocyte apoptosis through the miR-21-PTEN-AKT pathway was investigated by high-throughput RNA sequencing, fluorescence in situ hybridisation, luciferase reporter assays, and western blotting. Results: High-throughput RNA sequencing results showed that the AKT signalling pathway was up-regulated in the exosome group. Quantitative PCR and western blotting confirmed that the relative expression of genes in the AKT pathway was up-regulated. Western blotting revealed that AKT activated by exosomes inhibited osteocyte apoptosis. RNA fluorescence in situ hybridisation and luciferase reporter assays were performed to confirm the interaction between miR-21 and PTEN. According to the experiment in vivo, exosomes prevented GIONFH in a rat model as evidenced by micro-computed tomography scanning and histological and immunohistochemical analyses. Conclusions: Exosomes are effective at inhibiting osteocyte apoptosis (in MLO-Y4 cells) and at preventing rat GIONFH. These beneficial effects are mediated by the miR-21-PTEN-AKT signalling pathway.

15.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 33(8): 1029-1032, 2019 Aug 15.
Artigo em Chinês | MEDLINE | ID: mdl-31407564

RESUMO

Objective: To review the literature on the research status of vascularization of tissue engineered peripheral nerve so as to provide the theoretical basis for the vascularization of tissue engineered peripheral nerve. Methods: The literature related to the vascularization of peripheral nerve tissue engineering in recent years was reviewed and summarized according to the five aspects of promoting vascularization: local microenvironment and blood supply characteristics of peripheral nerve regeneration, scaffold material modification, seed cells, autologous vascular bundle implantation, and pro-vascular factors. Results: Tissue engineered peripheral nerve has brought a new hope for the repair of peripheral nerve injury, but the repair effect of large nerve defects is not good, which is mainly related to the degree of vascularization of the nerve grafts. So it is particularly important to promote the early vascularization of tissue engineered peripheral nerve. Previous studies have mainly focused on the four aspects of scaffold material modification, seed cells, autologous vascular bundle implantation, and angiogenesis related factors. Recent studies show that the combination of the above two or more factors in the tissue engineered peripheral nerves can better promote the vascularization of tissue engineered peripheral nerves. Conclusion: Promoting early vascularization of tissue engineered peripheral nerves can provide timely nutritional support for seed cells on the scaffold, promote axon growth and nerve regeneration, and facilitate the repair of large peripheral nerve defects in clinical practice.


Assuntos
Traumatismos dos Nervos Periféricos , Nervos Periféricos , Engenharia Tecidual , Humanos , Regeneração Nervosa , Tecidos Suporte
16.
ChemSusChem ; 12(18): 4249-4256, 2019 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-31321901

RESUMO

Nest-like porous graphene microspheres (NPGMs) are grown by using a chemical vapor deposition (CVD) method in a fluidized bed reactor from methane and basic magnesium carbonate microspheres (synthesized by a stirring-induced crystallization approach) as carbon source and template, respectively. The CVD-derived NPGMs have a few-layer structure and high electrical conductivity, as well as a three-dimensional individual macroarchitecture accompanied with well-developed pore channels and great structural integrity. As the electrode for a symmetric supercapacitor, the effect of different mass loadings for NPGMs-based electrodes on the capacitive energy-storage performance is investigated. Superior electrochemical properties with respect to gravimetric, areal, and total capacitances, rate capability, and durability are shown by the NPGMs-based symmetric supercapacitors, even at mass loadings up to 10 mg cm-2 . Moreover, the electrochemical behavior of the NPGMs-based electrode is much superior to those of two-dimensional lamella-like graphene and commercial activated carbon.

17.
Orthop Surg ; 11(4): 595-603, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31338971

RESUMO

OBJECTIVE: To compare the clinical therapeutic effect of transverse cancellous lag screw (TCLS) fixations and ordinary cannulated screw (OCS) fixations for vertical femoral neck fractures. METHODS: A total of 62 eligible patients with an average age of 56.2 years (range, 19-45 years; 40 male and 22 female) with Pauwels' type III femoral neck fractures were recruited in our study from January 2016 to December 2017. Among the patients, 30 underwent TCLS fixation (TCLS group), and the others were treated with OCS fixation (OCS group). The baseline data, perioperative outcomes (operative time, intra-operative blood loss, reduction quality, and hospital time), postoperative outcomes evaluated by a variety of scales including visual analogue scale (VAS) score, EuroQol five dimensions questionnaire (EQ-5D) and Harris hip scores (HHS), and complications (nonunion, femoral head necrosis, femoral neck shortening, and failure of fixation) of the two groups were recorded to compare at 12-month follow-up. RESULTS: The mean follow-up time of included patients was 13.4 ± 1.6 months in the TCLS group and 13.7 ± 0.9 months in the OCS group. There was no statistically significant difference in the baseline data as well as perioperative outcomes, including operative time, intra-operative blood loss, the hemoglobin difference before and after treatment, quality of reduction, and hospital time between two groups. Likewise, the VAS score, the EQ-5D score, and complications rates including nonunion and femoral head necrosis had no distinct difference in two groups. However, HHS in the TCLS group were superior to those in the OCS group at 12-month follow-up, and the femoral neck shortening rate was prominently reduced in the TCLS group when compared with the OCS group. CONCLUSIONS: Treating vertical femoral neck fractures with the TCLS technique could significantly improve hip functional recovery and reduce the postoperative femoral neck shortening rate. The present study provides novel insight for the treatment of vertical femoral neck fractures.


Assuntos
Parafusos Ósseos , Fraturas do Colo Femoral/cirurgia , Fixação Interna de Fraturas/instrumentação , Adulto , Perda Sanguínea Cirúrgica , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Medição da Dor , Inquéritos e Questionários , Adulto Jovem
18.
Nucl Med Commun ; 40(8): 778-785, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31116147

RESUMO

BACKGROUND: This study aimed to evaluate fused images of single-photon emission computed tomography/computed tomography (SPECT/CT), stand-alone whole-body scintigraphy (WBS) and stand-alone CT in the diagnosis of post-traumatic chronic-infected nonunion osteomyelitis (OST) of the lower limb. PATIENTS AND METHODS: The imaging data from 144 patients with known/suspected chronic-infected fracture nonunion in the lower limbs following internal/external fixation between June 2015 and December 2017 were reviewed retrospectively. Technetium-99m-methylene diphosphonate SPECT/CT scans were performed on the patients. For each patient, the diagnosis on the basis of each imaging approach was classified as yes (OST), no (no OST), or equivocal by experienced nuclear medicine physicians and radiologists. An intraoperative bacterial culture experiment was conducted as our gold standard. The diagnostic sensitivity, specificity, accuracy, positive predictive value, negative predictive value, κ coefficient, significance level, and agreement level were analyzed. RESULTS: The diagnosis on the basis of SPECT/CT fused images showed a sensitivity of 91.3%, a specificity of 84.6%, and accuracy of 88.9% compared to that based on WBS, with a sensitivity of 52.2%, a specificity of 15.4%, accuracy of 38.9%, and CT, with a sensitivity of 65.2%, a specificity of 23.1%, accuracy of 50.0%. The fused images can show the precise sites of post-traumatic chronic-infected OST. Considerable agreement (κ 0.679) was found between the SPECT/CT diagnosis and an intraoperative bacterial culture test (WBS, κ 0.218; CT, κ = 0.184). CONCLUSION: Technetium-99m-methylene diphosphonate SPECT/CT imaging fusion can improve diagnostic confidence for post-traumatic patients with chronic nonunion OST. This imaging approach can achieve an accurate diagnosis by revealing the precise location and scope of OST with high sensitivity and specificity, which has important implications for surgical guidance by providing the precise location of OST.


Assuntos
Extremidade Inferior/diagnóstico por imagem , Extremidade Inferior/lesões , Osteomielite/diagnóstico por imagem , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único , Medronato de Tecnécio Tc 99m , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Adulto Jovem
19.
J Bone Miner Metab ; 37(6): 1036-1047, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31087185

RESUMO

Eldecalcitol increased bone mineral density (BMD) and prevented vertebral fractures in vitamin D-sufficient osteoporotic subjects. However, the effect of eldecalcitol on BMD under vitamin D insufficiency is unknown. We examined the effect of eldecalcitol on BMD compared with alfacalcidol in osteoporotic patients without vitamin D or calcium supplementation. This is a randomized, double-blind, active comparator trial. 265 Chinese osteoporotic patients were randomly assigned to receive 0.75 µg eldecalcitol or 1.0 µg alfacalcidol for 12 months without vitamin D or calcium supplementation. Baseline calcium intakes were less than 550 mg/day and mean serum 25-hydroxyvitamin D [25(OH)D] was below 43 nmol/L in both groups. Baseline BMD tended to be lower in patients with lower calcium intake and serum 25(OH)D. Lumbar BMD increased by 2.05% higher in eldecalcitol than alfacalcidol group at 12 months. Total hip and femoral neck BMD also increased by 1.33 and 1.78%, respectively, in the eldecalcitol than the alfacalcidol group. The effect of eldecalcitol on BMD was not affected by serum 25(OH)D or calcium intake. The incidence of adverse events was not different between the two groups. Incidence of hypercalcemia in the edecalcitol group was not affected by serum 25(OH)D. In conclusion, baseline BMD tended to be lower in patients with low calcium intake and serum 25(OH)D. Eldecalcitol increased lumbar and hip BMD more than alfacalcidol regardless of serum 25(OH)D or calcium intake without vitamin D or calcium supplementation. These results suggest that eldecalcitol is effective in increasing the BMD of osteoporotic patients regardless of vitamin D status or calcium intake.Clinical Trial Registration number JAPIC CTI 152904.


Assuntos
Densidade Óssea/efeitos dos fármacos , Cálcio/farmacologia , Suplementos Nutricionais , Osteoporose/tratamento farmacológico , Osteoporose/fisiopatologia , Vitamina D/análogos & derivados , Vitamina D/farmacologia , Idoso , Biomarcadores/sangue , Conservadores da Densidade Óssea/farmacologia , Remodelação Óssea/efeitos dos fármacos , Cálcio/sangue , Cálcio/urina , Método Duplo-Cego , Feminino , Colo do Fêmur/efeitos dos fármacos , Colo do Fêmur/fisiopatologia , Quadril/fisiopatologia , Humanos , Vértebras Lombares/efeitos dos fármacos , Vértebras Lombares/fisiopatologia , Masculino , Pessoa de Meia-Idade , Osteoporose/sangue , Osteoporose/urina , Vitamina D/efeitos adversos , Vitamina D/sangue , Vitamina D/uso terapêutico
20.
World Neurosurg ; 128: e905-e911, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31096026

RESUMO

OBJECTIVE: Percutaneous full-endoscopic anterior cervical discectomy (PEACD) and posterior cervical foraminotomy (PCF) have been reported as effective treatments for the cervical spondylosis radiculopathy (CSR), but the biomechanical effects on the discs and facet joints of PEACD and PCF remain largely unclear. The purpose of this paper is to investigate and compare the biomechanical changes on cervical spine after PECAD and PCF procedures, thus providing evidences for surgeons to select a more appropriate approach. METHODS: An intact cervical C5-C6 digital model was constructed and then modified to obtain the PCF and PEACD models using finite element method. All the models were subjected to a 73.6N preload accompanied by a 1.8 Nm moment during flexion, extension, axial rotation, lateral bending. The range of motion (ROM), intervertebral disc pressure (IDP), facet joint contact area, and contact pressure were calculated under different loading conditions. RESULTS: The ROM of the PCF model changed slightly (0.28%), whereas that of the PEACD model increased significantly (20.49%) compared with intact model. The trend of IDP changes in these 2 surgical models were similar to ROM in the corresponding motion state. The contact pressure on the facet joint of the PEACD model increased by 20.53%, 33.38%, and 17.46% during extension, lateral bending, and axial bending, respectively, compared with the intact model, and the PCF increased by 33.53% and 16.16% during extension and lateral bending, respectively, whereas it decreased 0.97% in axial rotation. The facet joint contact area of the PCF model increased by 85.71%, 1.54%, and 2.17% during extension, lateral bending, and axial rotation, respectively, and the area of the PEACD model increased by 157.14% and 36.96% during extension and axial rotation, whereas it decreased by 13.85% during lateral bending. CONCLUSIONS: This is the first biomechanical finite element study comparing PEACD with PCF for the treatment of CSR. Our results showed that PEACD led to hypermobility with high IDP within the cervical segment undergone surgery, whereas the ROM and IDP changed slightly after PCF. The variations of the contact stress indicated that both procedures changed the transmission path of the force on the facet joint and may accelerate the degeneration of the facet joint. PCF may be a better choice for the treatment of CSR compared with PEACD.


Assuntos
Vértebras Cervicais/cirurgia , Discotomia Percutânea/métodos , Forame Magno/cirurgia , Adulto , Fenômenos Biomecânicos , Vértebras Cervicais/diagnóstico por imagem , Análise de Elementos Finitos , Forame Magno/diagnóstico por imagem , Humanos , Disco Intervertebral/cirurgia , Masculino , Radiculopatia/diagnóstico por imagem , Radiculopatia/cirurgia , Espondilose/diagnóstico por imagem , Espondilose/cirurgia , Tomografia Computadorizada por Raios X , Articulação Zigapofisária/diagnóstico por imagem , Articulação Zigapofisária/cirurgia
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