Medial tibial plateau sustaining higher physiological stress than the lateral plateau: based on 3D printing and finite element method.

BACKGROUND: Medial compartment knee osteoarthritis (KOA) accounts for most KOA cases, and increased trabecular bone volume fraction (BV/TV) is one of the pathological changes in the tibial plateau of KOA. How BV/TV changes before and after the menopause and its effects on medial compartment KOA are yet to be clarified. METHODS: Twenty femurs from twenty 12-week-old rats were included. The operated group underwent ovariectomy (to represent the osteoporosis condition), called the O group, and the non-operated group was the normal control, called the N group. Micro-CT scans of the femoral condyles were acquired 12 weeks after the surgery, and the volume of interest (VOI) of medial-, inter-, and lateral-condyle trabeculae were three-dimensional (3D) printed for uniaxial compression mechanical test and simulated by the finite element (FE) method. RESULTS: The results demonstrated that the O group indicated poorer trabecular architecture than the N group in three parts of the femoral condyle, especially in the intercondyle. Within the group, the BV/TV, trabecular thickness (Tb.Th), and trabecular number (Tb.N) ratios between the medial and lateral condyles were greater than 1 in both N and O groups. The medial condyle trabeculae's mechanical properties were higher than those of the lateral condyle, and this superiority appears to be broadened under osteoporotic conditions. FE modelling well reproduced these mechanical differentiations. CONCLUSIONS: According to Wolff's law, the higher BV/TV and mechanical properties of the medial femoral condyle may be due to inherent imbalanced loading on the knee component. Alterations in BV/TV and their corresponding mechanical properties may accompany KOA.

Do stress fractures induce hypertrophy of the grafted fibula? A report of three cases received free vascularized fibular graft treatment for tibial defects.

The presence of large segmental defects of the diaphyseal bone is challenging for orthopedic surgeons. Free vascularized fibular grafting (FVFG) is considered to be a reliable reconstructive procedure. Stress fractures are a common complication following this surgery, and hypertrophy is the main physiological change of the grafted fibula. The exact mechanism of hypertrophy is not completely known. To the best of our knowledge, no studies have examined the possible relationship between stress fractures and hypertrophy. We herein report three cases of patients underwent FVFG. Two of them developed stress fractures and significant hypertrophy, while the remaining patient developed neither stress fractures nor significant hypertrophy. This phenomenon indicates that a relationship may exist between stress fractures and hypertrophy of the grafted fibula, specifically, that the presence of a stress fracture may initiate the process of hypertrophy.

A prospective study concerning the relationship between metal allergy and post-operative pain following total hip and knee arthroplasty.

PURPOSE: A prospective study was conducted to detect whether a relationship exists between metal allergy and post-operative pain in total hip and knee arthroplasty patients. We postulated that to some extent a relationship does exist between them. MATERIALS AND METHODS: Patients who had undergone total hip and knee arthroplasty surgery because of hip and knee disease were included. The exclusion criteria were patients who were treated with immunosuppressor two weeks pre-operatively, skin conditions around the patch testing site, and other uncontrollable factors. Each patient agreed to patch testing for three days before surgery. Photographic images before patch testing, two and three days after patch testing were obtained to evaluate the final incidence of metal allergy. The patch tests contained 12 metal elements; chromium, cobalt, nickel, molybdenum, titanium, aluminium, vanadium, iron, manganese, tin, zirconium, and copper. Two independent observers evaluated the images. The results were divided into a non-metal allergy group and a metal allergy group. Pre-operative and postoperative VAS score, lymphocyte transforming test, and X-rays were collected to detect the relationship between metal allergy and post-operative pain following total hip and knee arthroplasty. RESULTS: There were 96 patients who underwent pre-operative patch testing. The overall metal allergy rate was 51.1% (49/96) in our study. Nickel, cobalt, manganese, and tin were the most common allergic metal elements in our study. Nine inappropriate cases were excluded, and 87 patients were finally included in our study. There were 36 metal allergy and 26 non-metal allergy patients in the THA group, while 11 metal allergy and 14 non-metal allergy patients were found in the TKA group. We found no relationship existed between metal allergy and post-surgery pain in total hip and knee arthroplasty. CONCLUSION: Pain caused by metal allergy usually presents as persistent and recurrent pain. The white cell count, C-reactive protein, erythrocyte sedimentation rate and postoperative radiographs were not affected. Currently, patch testing and lymphocyte transforming tests are used for metal allergy diagnosis. We deemed that a relationship between post-surgery pain and metal allergy in total hip and knee patients may exist to some extent. Larger samples and longer follow-up time are essential for further study.

Vascularised greater trochanter bone graft, combined free iliac flap and impaction bone grafting for osteonecrosis of the femoral head.

PURPOSE: To investigate the curative efficacy of osteonecrosis of the femoral head (ONFH) in a hip-preserving operative approach, by grafting a vascularized greater trochanter flap combined with a free iliac flap, in an attempt to seek an innovative approach for patients who suffered middle to late stage ONFH without total hip arthroplasty (THA) surgery. METHOD: Our research included a total of 60 patients (66 hips) who accepted hip-preserving surgery by grafting a vascularized greater trochanter flap combined with a free iliac flap which was tightly filled by hammering because of ONFH (most were Association Research Circulation Osseous (ARCO) stage III patients) from January, 2006 to December, 2010. A Harris Hip Score was obtained during follow-ups, evaluating the clinical efficacy, X-rays were taken regularly for image assessing, and the SF-36 scale was used for estimating quality of life. Terminal observation time was considered when patients had symptom-dependant indications for performing another hip-preserving surgery or THA surgery. RESULTS: Fifty-eight patients (64 hips) were eventually contacted by telephone for an out-patient clinic return visit, with a mean follow-up time of 35.8 months (varied from 12 months to 60 months), but two patients lost contact for various reasons. The demographic data were as follows: there were 16 ARCO IIIA cases, 22 ARCO IIIB cases, and 26 ARCO IIIC cases, respectively. Postoperative X-rays revealed a well-repaired necrotic area of the femoral head and improvement of femoral-acetabulum coverage. The last follow-up mean Harris Hip Score was 86.56 ± 7.38 (excellent results reached 87.50%), which were greatly improved compared to 50.95 ± 6.86 pre-operatively. Also the postoperative mean scores of all dimensions of the SF-36 scale were improved to some extent. Additionally the physical component summary (PSC) scores were enhanced from 42 ± 13 pre-operatively to 78 ± 11, while the postoperative mental component summary (MCS) scores (76 ± 11) largely increased in contrast to pre-operative scores (51 ± 10), with both target indices having statistical significance (p = 0.005, p = 0.01), signifying hugely improvement of the quality of life of the patients. A correlation was found between Harris Hip Score and all dimensions of SF-36 scale (r = 0.32-0.72), especially closely correlated with physical functioning (PF), role-physical (RP) and bodily pain (BP) in PCS aspect (r = 0.72, p < 0.01; r = 0.58, p < 0.01; r = 0.65, p < 0.01, respectively). CONCLUSION: There is definite curative efficacy for the treatment of ONFH with an hip-preserving operative approach by grafting a vascularized greater trochanter flap combined with a free iliac flap which was tightly filled by hammering. This kind of operative approach reconstructs the biological stability of femoral head, which promotes repair of necrotic areas and indirectly preserves the femoral head of patients and a majority of hip function. It possesses vast clinical as well as practical significance, because the long-term efficacy can satisfy fundamental life requirements, especially for those young and middle-aged patients who suffer ONFH to avoid or put off the time of total hip arthroplasty (THA) surgery.

Studying trabecular bone samples demonstrates a power law relation between deteriorated structure and mechanical properties - a study combining 3D printing with the finite element method.

Introduction: The bone volume fraction (BV/TV) significantly contributes to the mechanical properties of trabecular bone. However, when studies compare normal trabeculae against osteoporotic trabeculae (in terms of BV/TV decrease), only an "average" mechanical result has been determined because of the limitation that no two trabecular structures are the same and that each unique trabecular structure can be mechanically tested only once. The mathematic relation between individual structural deterioration and mechanical properties during aging or the osteoporosis process has yet to be further clarified. Three-dimensional (3D) printing and micro-CT-based finite element method (µFEM) can assist in overcoming this issue. Methods: In this study, we 3D printed structural-identical but BV/TV value-attenuated trabecular bones (scaled up ×20) from the distal femur of healthy and ovariectomized rats and performed compression mechanical tests. Corresponding µFEM models were also established for simulations. The tissue modulus and strength of 3D printed trabecular bones as well as the effective tissue modulus (denoted as Ez) derived from µFEM models were finally corrected by the side-artifact correction factor. Results: The results showed that the tissue modulus corrected, strength corrected and Ez corrected exhibited a significant power law function of BV/TV in structural-identical but BV/TV value-attenuated trabecular samples. Discussion: Using 3D printed bones, this study confirms the long-known relationship measured in trabecular tissue with varying volume fractions. In the future, 3D printing may help us attain better bone strength evaluations and even personal fracture risk assessments for patients who suffer from osteoporosis.

Combined computational analysis and cytology show limited depth osteogenic effect on bone defects in negative pressure wound therapy.

Background: The treatment of bone defects remains a clinical challenge. The effect of negative pressure wound therapy (NPWT) on osteogenesis in bone defects has been recognized; however, bone marrow fluid dynamics under negative pressure (NP) remain unknown. In this study, we aimed to examine the marrow fluid mechanics within trabeculae by computational fluid dynamics (CFD), and to verify osteogenic gene expression, osteogenic differentiation to investigate the osteogenic depth under NP. Methods: The human femoral head is scanned using micro-CT to segment the volume of interest (VOI) trabeculae. The VOI trabeculae CFD model simulating the bone marrow cavity is developed by combining the Hypermesh and ANSYS software. The effect of trabecular anisotropy is investigated, and bone regeneration effects are simulated under NP scales of -80, -120, -160, and -200 mmHg. The working distance (WD) is proposed to describe the suction depth of the NP. Finally, gene sequence analysis, cytological experiments including bone mesenchymal stem cells (BMSCs) proliferation and osteogenic differentiation are conducted after the BMSCs are cultured under the same NP scale. Results: The pressure, shear stress on trabeculae, and marrow fluid velocity decrease exponentially with an increase in WD. The hydromechanics of fluid at any WD inside the marrow cavity can be theoretically quantified. The NP scale significantly affects the fluid properties, especially those fluid close to the NP source; however, the effect of the NP scale become marginal as WD deepens. Anisotropy of trabecular structure coupled with the anisotropic hydrodynamic behavior of bone marrow; An NP of -120 mmHg demonstrates the majority of bone formation-related genes, as well as the most effective proliferation and osteogenic differentiation of BMSCs compared to the other NP scales. Conclusion: An NP of -120 mmHg may have the optimal activated ability to promote osteogenesis, but the effective WD may be limited to a certain depth. These findings help improve the understanding of fluid mechanisms behind NPWT in treating bone defects.

Synovial calprotectin for the diagnosis of periprosthetic joint infection: a diagnostic meta-analysis.

BACKGROUND: Periprosthetic joint infections (PJI) are a rare but severe complication of total joint arthroplasty (TJA). However, the diagnosis of PJI remains difficult. It is one of the research that focuses about diagnosis for PJI for majority researchers to discover a novel biomarker. This meta-analysis tried to evaluate diagnostic value of synovial calprotectin for PJI. METHODS: This meta-analysis search of the literature was conducted in PubMed, EMBASE, Web of Science, and the Cochrane Library. Literature quality was appraised using Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) based on RevMan (version 5.3). The diagnostic value of calprotectin for PJI was evaluated by calculating sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), diagnostic score and area under SROC (AUC) based on the Stata version 14.0 software. We conduct subgroup analysis according to the study design, cutoff values, the country of study, and gold standard. RESULTS: Seven studies were included in this meta-analysis. The pooled sensitivity of synovial calprotectin for the diagnosis of PJI was 0.94 (95% CI, 0.87-0.98), and the specificity was 0.93 (95% CI, 0.87-0.96). The pooled AUC, PLR, and NLR for synovial calprotectin were 0.98 (95% CI, 0.96-0.99), 13.65 (95% CI, 6.89-27.07), and 0.06 (95% CI, 0.02-0.15), respectively. The pooled diagnostic score and DOR were 5.4 (95% CI, 3.96-6.85) and 222.32 (95% CI, 52.52-941.12), respectively. CONCLUSION: In summary, this meta-analysis indicates that synovial calprotectin is a promising biomarker of assistant diagnosis for PJI, as well as recommended test for excluding diagnostic tool.

[Human osteoblast-like cells OS-732 intervened with alcohol and treated with liuweidihuang pill medicated serum].

OBJECTIVE: To investigate the mechanism of osteonecrosis of the femoral head caused by alcohol and the therapeutic effects of the method of invigorating the kidney. METHODS: The osteoblast-like cells were intervened with 0.3, 0.9, 1.5 mol/L alcohol and observed by flow cytometry and light microscopy and electro microscopy. The cells intervened by 0.15 mol/L alcohol were treated with liuweidihuang pill medicated serum and observed by flow cytometry and light microscopy and electro microscopy. RESULTS: Apoptosis rate and the degree of cell necrosis had positive correlation with the concentration and the acting time of alcohol. The polymorphism of cells wer turned into roundness, and the cellular ecphyma was shortened and thinning, ribosome and endocytoplasmic reticulum were diminished. Part of the ruffle in mitochondria was disappeared. After treatment, the cellular ecphyma was recovered and the endoplasmic reticulum and golgi apparatus were visible. CONCLUSION: The osteoblast-like cells could be necrosis and apoptosis by the alcohol and were positive correlation with the intervened concentration and acting time. Chinese medicine with method of invigorating the kidney has effect on rehabilitating the cellular activity.

Three dimensional finite element analysis of the influence of posterior tibial slope on the anterior cruciate ligament and knee joint forward stability.

OBJECTIVE: To explore the biomechanical influence of posterior tibial angle on the anterior cruciate ligament and knee joint forward stability. METHODS: The left knee joint of a healthy volunteer was scanned by CT and MRI. The data were imported into Mimics software to obtain 3D models of bone, cartilage, meniscus and ligament structures, and then Geomagic software was used to modify of the image. The relative displacement between tibia and femur and the stress of ACL were recorded. RESULTS: ACL tension was 12.195 N in model with 2∘ PTS, 12.639 N in model with 7∘ PTS, 18.658 N in model with 12∘ PTS. the relative displacement of the tibia and femur was 2.735 mm in model with 2∘ PTS, 3.086 mm in model with 7∘ PTS, 3.881 mm in model with 12∘ PTS. In the model with 30∘ flexion, the maximum tension of ACL was 24.585 N in model with 2∘ PTS, 25.612 N in model with 7∘ PTS, 31.481 N in model with 12∘ PTS. The relative displacement of the tibia and femur was 5.590 mm in model with 2∘ PTS, 6.721 mm in model with 7∘ PTS, 6.952 mm in model with 12∘ PTS. In the 90∘ flexion models, ACL tension was 5.119 N in model with 2∘ PTS, 8.674 N in model with 7∘ PTS, 9.314 N in model with 12∘ PTS. The relative displacement of the tibia and femur was 0.276 mm in model with 2∘ PTS, 0.577 mm in model with 7∘ PTS, 0.602 mm in model with 12∘ PTS. CONCLUSION: The steeper PTS may be a risk factor in ACL injury.

Differential expression of miR-195-5p in collapse of steroid-induced osteonecrosis of the femoral head.

BACKGROUND: Femoral head collapse is a key reference point for determining a treatment regimen of femoral head osteonecrosis. However, there are no effective preventive measures and the efficacy of hip-preserving surgery is unsatisfactory due to the unclear mechanism of collapse. This study aimed to identify and validate miRNAs differentially expressed in collapse and non-collapse areas of the osteonecrotic femoral head, and to predict the target genes and pathways of these miRNAs. RESULTS: Nine samples passed the quality control test. A total of 2085 differentially expressed miRNAs were detected, among which 433 miRNAs showed differential expression in the T1 group compared to the W1 group; 344 miRNAs showed differential expression in the T2 group compared to the W2 group; 107 miRNAs showed differential expression in the T3 group compared to the W3 group. After combining data from all three patients, 10 miRNAs showed differential expression in the collapse area (T1+T2+T3) compared to the non-collapse area (W1+W2+W3). Compared to the normal area, has-miR-195-5p showed the most significant downregulation. Expression results from RT-PCR revealed that the expression of hsa-miR-195-5p in the collapse area (T1+T2+T3) was significantly lower than that in the non-collapse area (W1+W2+W3) and normal area (Z1+Z2+Z3). 157 genes were perdicted as the target gene of hsa-miR-195-5p. MATERIALS AND METHODS: Femoral heads of three patients (2 males and 1 female) treated by total hip arthroplasty surgery for steroid-induced femoral head osteonecrosis were selected based on inclusion and exclusion criteria. Bone tissue samples were obtained from the collapse area (T), non-collapse area (W), and normal area (Z) according to the anatomical structure of osteonecrotic femoral heads. Total RNA was extracted from the samples and the microarray chip was scanned. miRNAs showing differential expressions of more than 1.5-fold were selected and was validated by RT-PCR. TargetScan, mirBase and miRanda bioinformatics software was used to predict target genes and identify possible pathways involving these genes. CONCLUSIONS: miR-195-5p showed the most significant difference in the collapse area of osteonecrotic femoral heads, suggesting that collapse may be related to the downregulation of miR-195-5p.

[CLINICAL STUDY OF INTERNAL TENSION-RELIEVING TECHNIQUE IN ARTHROSCOPIC ASSISTED ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION].

OBJECTIVE: To study the effectiveness of internal tension-relieving technique for arthroscopic assisted anterior cruciate ligament (ACL) reconstruction. METHODS: Between March 2011 and September 2014, 51 cases of complete ACL rupture were randomly divided into 2 groups. Arthroscopic assisted single-bundle ACL reconstruction combined with internal tension-relieving technique was performed in 26 cases (group A), arthroscopic assisted single-bundle ACL reconstruction in 25 cases (group B). There was no significant difference in gender, age, cause of injury, injured side, body mass index, Outerbridge classification of articular cartilage injury, disease duration, and the preoperative International Knee Documentation Committee (IKDC) score, Lysholm score, and KT-1000 test value between 2 groups (P>0.05). At 3, 6, and 12 months after operation, the KT-1000 was used to measure the anterior stability, and IKDC and Lysholm scores to evaluate the function of knee joint. RESULTS: Healing of incision by first intention was obtained in all patients of 2 groups, without complications of infection, deep vein thrombosis of lower extremity, and blood vessels and nerves injury. The patients were followed up 12 months after operation. All patients received second microscopic examination. The reconstructed ACL had good continuity and good coverage of synovial tissue. There was no re-rupture in any cases. The range of motion of the knee joint was close to normal. The MRI showed good healing of the ligament and the bone tunnel at 12 months after operation. KT-1000 test value, IKDC score, and Lysholm score at 3, 6, and 12 months after operation were significantly improved when compared with preoperative ones (P<0.05), but no significant difference was found among different time points after operation (P>0.05). There was no significant difference in IKDC score and Lysholm score between 2 groups at 3 and 12 months (P>0.05); but IKDC score and Lysholm score of group A were significantly higher than those of group B (P<0.05) at 6 months. At diffenent time points after operation, the KT-1000 test values of group A were significantly lower than those of group B (P<0.05) except the value at 3 months (P>0.05). CONCLUSION: For patients with ACL rupture, using internal tension-relieving technique can effectively alleviate tension force of reconstructed ligament, which is beneficial to the healing of reconstructed ligament and early rehabilitation of the knee joint.

Differential expression of miR-672-5p and miR-146a-5p in osteoblasts in rats after steroid intervention.

BACKGROUND: Apoptosis of osteoblasts and osteocytes is one cause of steroid-induced osteonecrosis of the femoral head; however, the molecular mechanism of steroid affecting osteoblasts at the genetic level is unclear. The aim of the present work is to examine differential expression of osteoblasts in rats after steroid intervention and to verify expression by real-time polymerase chain reaction (RT-PCR). METHODS: Primary culture, passaging and identification of osteoblasts of SD neonatal rats were conducted; osteoblasts were divided into two groups, the control group, and the steroid group. Total RNA was extracted separately, and quality control was performed; by means of RNA labeling and microarray hybridization, data were collected and then standardized to ascertain differences in miRNA expression between the two groups. The gene expression spectrum was analyzed. Obvious differential expression of miR-672-5p and miR-146a-5p was verified by RT-PCR. Miranda, microcosm and mirdb bioinformatics software were used to predict target genes. RESULTS: Compared with the control group, morphologically, the osteoblasts in the steroid group were more irregular and showed various shapes. The number of miRNAs (fold change >2) in the steroid group was six. Four miRNAs were upregulated and two miRNAs were downregulated. In particular, upregulated miR-672-5p expression and downregulated miR-146a-5p expression were significant. RT-PCR results showed that the 2(-△△) CT value of miR-672-5p in the steroid group was 3.743-fold of that in the control group, and the 2(-△△) CT value of miR-146a-5p in the steroid group was 0.322-fold of that in the control group. Angptl4, Ccdc51, Ssbp3 and RGD1306991 were predicted as the target gene of miR-672-5p, while Hrp12 was that of miR-146a-5p. CONCLUSION: Expression profiles of miR-672-5p and miR-146a-5p had the most significant changes in the osteoblasts of rats with steroid intervention, which may provide a new viewpoint to pathogenesis of osteonecrosis of the femoral head.

Functional proteome of bones in rats with osteoporosis following ovariectomy.

Osteoporosis is a chronic condition chiefly affecting postmenopausal women, in whom the skeleton loses a significant percentage of its mineralized mass and mechanical resiliency, thereby becoming prone to fracture. Although the effect of the loss of estrogen on bone metabolism has been documented, its mechanism is still poorly understood. In the present proteomic study, we characterized the effect of estrogen deficiency on protein expression in rat bones. Using two-dimensional gel electrophoresis, mass spectrometry and rat protein database, we successfully identified three distinctly changed proteins named thioredoxin peroxidase 1, myosin light polypeptide 2 and ubiquitin-conjugating enzyme E2-17 kD, among which ubiquitin-conjugating enzyme E2-17 kD has been documented to be an estrogen-related protein, but the other two are first reported to be osteoporosis-related proteins in the current study. These results provide valuable experimental evidences for the elucidation of the molecular mechanism of osteoporosis related to the loss of estrogen.

[Effects of Shengmai Chenggu capsule on proliferation and vascular endothelial growth factor secretion of vascular endothelial cells].

OBJECTIVE: To study the effect of the serum of rabbits fed with Shengmai Chenggu capsule (SMCGC), a preparation of traditional Chinese medicine, on the proliferation and vascular endothelial growth factor (VEGF) secretion of cultured ECV304 cells. METHODS: The drug-containing serum from rabbits with intragastric administration of SMCGC at different doses was obtained for treatment of ECV304 cells cultured in vitro, with the cells treated with blank serum and ligustrazine serving as the control. The proliferation of ECV304 cells was detected by MTT assay and VEGF concentration in the culture medium of the cells measured by means of ELISA. The ultrastructure of ECV304 cells treated with the sera for 12 h was observed by transmission electron microscopy. RESULTS: After treatment with SMCGC-containing rabbit serum for 12 and 36 h, respectively, the proliferation of ECV304 cells in all dosage groups showed no significant increases (P>0.05), and the sera of rabbits fed with medium and high doses of SMCGC significantly inhibited the proliferation of ECV304 cells after a 36-hour treatment (P<0.01). The high-dose rabbit serum might even cause apoptosis of ECV304 cells, and low-dose serum significantly stimulated VEGF secretion of the ECV304 cells (P<0.01). CONCLUSIONS: SMCGC does not promote the proliferation of ECV304 cells, and the serum of low-dose SMCGC-treated rabbits may stimulate VEGF secretion of the ECV304 cells, which might be the main mechanism of SMCGC in stimulating angiogenesis.

Effects of the Chinese drugs for activating blood circulation on plasma TXB2 and 6-keto-PGF1alpha contents in rabbits with glucocorticoid-induced femoral head necrosis.

In the femoral head necrosis model rabbit induced by endotoxin combined with methylprenisolone, the dynamical changes of plasma TXB2 and 6-keto-PGF1alpha contents were observed. As a result, microscopic examination showed that in the model group, bone trabeculae became fine, empty bone lacunae increased, and osteoblasts in number decreased; the ratio of TXB2 and 6-keto-PGF1alpha was out of balance, and these changes worsened gradually with the lapse of time; Compound Sheng Mai Cheng Gu Capsules could reverse femoral head necrosis, protect the vascular endothelial cells, recover the balance of TXB2 and 6-keto-PGF1alpha. It is concluded that the hormone-induced femoral head necrosis is closely related with blood stasis, and that the Chinese drugs for activating blood circulation and removing blood stasis can prevent the femoral head from development of necrosis.

[Experimental study of directional differentiation of bone mesenchymal stem cells (BMSCs) to osteoblasts guided by serum containing cistanche deserticola].

OBJECTIVE: To study directional differentiation of BMSCs guided by Desert living Cistanche (Herba Cistanches) which invigorates the kidney. METHODS: Primary BMSCs were obtained by whole bone marrow culture and subcultured to the fourth generation by trypsin digestion, and than inoculated into two six-well plates at 5 x 10(6) cells per milliliter, all the plates were divided into three groups as blank group, Dexamethasone (DXM) group and Herba Cistanches group, three wells in each group, medium were changed at day 2. The blank group were changed with L-DMEM containing 10% FBS. The DXM group were changed with medium containing 10 mmol/L beta-sodium glycerophosphate, 0.1 micromol/L DXM and 50 mg/L vitamin C. The Herba Cistanches group were changed with medium containing 10% blood serum containing Herba Cistanches and L-DMEM. One of the six-well plates was stained by alkaline phosphatase (AKP) at the tenth day,the other one was stained by alizarin Bordeaux at the twentieth day. RESULTS: At the tenth day DXM group and Herba Cistanches group were ALKP stained positive; from the 12th day,white calcium nodus could be seen at the surface of the wells; which alizarin stained positive by the twentyth day. CONCLUSION: The medium containing Herba Cistanches can guide BMSCs to differentiate into osteoblast, which promises a favorable prospect for the treatment of osteoporosis and bone fracture disunion.

Haemostatic efficacy of an ethyl-2-cyanoacrylate-based aerosol in combination with tourniquet application in a large wound model with an arterial injury.

BACKGROUND: Tourniquet application is the standard method for the control of severe trauma haemorrhage. However, it may result in severe ischaemic injuries when used for a long time. In this study, we developed a modified ethyl-2-cyanoacrylate-based aerosol (ECA) aerosol spray and determined its efficacy for short-time control of bleeding of large wounds in pigs when used in combination with tourniquet application. METHODS: A large wound model with a femoral arterial injury was made in the middle of either thigh of the pig. Thirty white female hybrid pigs were divided evenly and randomly into three groups, including tourniquet application only group (group A), tourniquet-ECA group (group B, a combination of ECA with tourniquet application) and tourniquet-ECA with wound cleaning group (group C, a combination of ECA with tourniquet application plus wound cleaning). RESULTS: The success rates of haemostasis were 0%, 30%and 90% in groups A, B and C, respectively (P<0.05). The incidence of haematoma and the membrane forming time were 100% and 20%, and 5.9+/-1.0min and 8.3+/-1.1min, respectively, in groups B and C (both P<0.05). The haemostatic time and the thickness of membrane were 11.9+/-1.8min and 10.2+/-1.4min, and 0.68+/-0.29mm and 0.79+/-0.25mm, respectively, in the two groups (P>0.05, both). CONCLUSION: The ECA spray achieves haemostasis within a very short time when it is used in combination with tourniquet application in a large wound model with an arterial injury. It may effectively prevent the wound from bleeding without the need for any long-term pressure bandage to wrap the wound, and it is easy to be disposed in debridement. Therefore, it may serve as an optimal choice for the first aid of large wounds with an arterial injury.

[Treatment for ipsilateral fractures of the femoral neck and shaft].

OBJECTIVE: To investigate the curative effect of different internal fixation for ipsilateral fractures of the femoral neck and shaft. METHODS: By retrospective study of 27 patients who sustained ipsilateral femoral shaft and neck fractures from June 1993 to March 2004. There were 22 male and 5 female, with an average age of 35 years (range in 14 to 65 years). The femoral neck and shaft fractures were stabilized with dynamic hip screw system (DHS) in 3 cases,with dynamic compression plate and cannulated lag screw in 12 cases, with constructive nail in 8 cases, with antegrade intramedullary locking nail and cannulated lag screw in 4 cases. There were 13 cases used of the temporary fixation of Kirschner wire before the pexia of the femoral neck fractures. RESULTS: All of the patients were followed up for 36 to 75 months, with an average of 44 months. The average healing period of femoral neck fracture was 4.5 months in 25 cases, nonunion of femoral neck fractures in 2. The average healing period of femoral shaft fracture was 6 months in 27 cases. In 14 cases that not using temporary fixation of femoral neck with Kirschner wire, there were nonunion of femoral neck in 2 and slight coxa vara in 3. CONCLUSION: There are a wide choice of internal fixation method for treatment of ipsilateral fracture of the femoral neck and shaft, the fixation with dynamic compression plate and cannulated lag screw is a handy method. It would be avoided to the replacement and trauma, emporary fixing the fracture with Kirschner wire before the pexia of the femoral neck fracture.