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Osteoarthritis (OA) is a common degenerative disease. Its most significant pathological change is destruction of articular cartilage and the main clinical symptoms are pain and dysfunction of joints. Recent studies have shown that the expression of non-coding RNA (ncRNA) in chondrocytes can abnormally up-regulate or down-regulate and alter the activities of chondrocytes like their proliferation, migration and apoptosis, thus leading to the occurrence and development of osteoarthritis. Exosomes are extracellular vesicles with a diameter of 40-100 nm, which are secreted in intercellular fluid, act as medium of intercellular communication. They protect ncRNA, protein, lipid and other bioactive materials from enzymatic degradation by encapsulating them and transferring to sibling chondrocytes, due to their good tissue permeability. They can also improve communication between cells and regulate the activities of chondrocytes. Thus, exosomes behave like gene carriers. The ncRNA carried by exosomes can supplement or adsorb the abnormal ncRNA in chondrocytes, so as to regulate the activity of chondrocytes, and is therefore considered as a possible candidate with capabilities to repair cartilages. In this study we reviewed existing literatures related to the roles and effects of exosome miRNA, lncRNA and circRNA on osteoarthritis. We also reviewed the pathogenesis of exosome ncRNA in osteoarthritis.
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Objective To explore the relationship between apoptosis promoting effector molecules TFAR19,Apaf-1 and lubar intervertebral disc protrusion.Methods 99 of operation patients with lubar intervertebral disc protrusion in the First Affiliated Hospital of Guangxi Medical University Department of Spine and Osteoputhy were recruited.Among them,single segment of lubar intervertebral disc protrusion were 70 (Group A),more than one segments of lubar intervertebral disc protrusion were 29 (Group B).In addition,40 unrelated healthy people from physical examination center were enrolled as controls (Group C).Enzyme-linked immunosorbent assay (ELISA) was used to examine serum TFAR19,Apaf-1 levels in lubar intervertebral disc protrusion patients.Results The level of TFAR19 in Group A,Group B and Group C respectively were 1.85±0.14,2.33±0.25 and 1.30±0.09 ng/ml.The TFAR19 activity in each group was statistically significant difference (F=7.979,P＜0.01).Compared with Group C,the TFAR19 activity in Group B (q=5.59,P＜0.01),Group A (q=3.60,P=0.012) was statistically significant difference.The TFAR19 activity in lubar intervertebral disc protrusion patients subgroups (Group A,Group B) was statistically significant difference (q =2.93,P =0.012).The level of Apaf-1 in Group A,Group B and Group C respectively were 159.22±11.87,203.20±20.21 and 107.52±11.58 pg/ml.The Apaf-1 activity in each group was statistically significant difference (F=8.828,P＜0.01).Compared with Group C,the Apaf-1 activity in Group B (q=5.86,P＜0.01),Group A (q=3.89,P=0.007) was statistically significant difference.The Apaf-1 activity in lubar intervertebral disc protrusion patients subgroups (Group A,Group B) was statistically significant difference (q =2.97,P=0.037).Male/female ratio between each groups was not statistically significant difference (x2=0.229,P =0.892).Age between each groups was not statistically significant difference (F=0.091,P =0.91).Conclusion The augment of TFAR19 and Apaf-1 promotes apoptosis of lubar intervertebral disc protrusion.It is connected with quantity of protrusive segments.The more segments of protrusion,the higher TFAR19 and Apaf-1 level of examination will be.
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Objective To investigate the surgical strategy and outcome for occipitocervical extramedullary tumors.Methods 15 patients with occipitocervical extramedullary tumors from January 2007 to July 2010 were reviewed retrospectively.There were 7 males and 8 females with an mean age of 44.6 years (range,21-72 years).All cases were intradural tumors,including 7 cases in dorsolateral,5 cases in lateral side,and 3 cases in ventralis of spinal cord.Functional and neurological statuses were assessed using the Frankel grade and Japanese Orthopaedic Association (JOA) scale.According to Frankel grade system,there were 4 patients with Grade C,8 with Grade D,and 3 with Grade E.The mean preoperative JOA score was 10.5±3.6.Based on the tumor site,there were 5 cases in medulla oblongata-C1 and 10 cases in C1,2.Frankel grade and JOA score were used to evaluate neurological status and general health.The improvement of symptoms and characteristics of surgical strategies were analyzed.Results All cases were followed up for 2-4 years (mean 2.8 years).Complete resection of tumor and good fusion of bone graft were found in radiography postoperatively.The pathological diagnoses included 10 cases of schwannoma,3 cases of meningioma and 2 cases of neurofibroma.There was statistical difference between the preoperative and the final follow-up functional and neurological statuses including Frankel grade and JOA score.At the latest follow-up,2 cases improved from Frankel grade C to D,2from C to E,6 from D to E,but none in 2 cases with grade D.The mean JOA score at final follow-up was 15.6±1.6,and the average improvement rate was 80.7％± 17.4％.The mean preoperative C0-2 angle was 27.0°±4.1 °,and C2-7 angle was 16.8°± 12.7°.C0-2 angle was 27.6°±8.8°,and C2-7 angle was 10.2°±6.8° at the latest follow-up.However,these differences did not reach statistical significance.Conclusion Surgical treatment can effectively maintain or improve neurological function and improve quality of life.Extramedullary tumors can be resected completely by posterior approach,and spinal stabilization can be obtained satisfactorily through selecting appropriate surgical strategies.For medulla oblongata-C1 level,occipitocervical fusion is usually chosen after extirpation of tumor.For C 1,2 level,C1,2 fusion after tumor resection is useful in preventing atlantoaxial instability.
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<p><b>OBJECTIVE</b>To establish a mouse model of spinal metastasis of human prostate cancer using fluorescence-labeled PC-3 cells to allow direct observation by in vivo imaging.</p><p><b>METHODS</b>PC-3 cells were infected with a lentivirus carrying green fluorescence protein (GFP) gene. The GFP-positive cell clone was expanded and prepared into cell suspension for injection into the inferior vena cava of nude mice. The tumor growth and metastasis in the mice was directly observed using an in vivo fluorescence imaging system. The tumor-bearing mice were sacrificed after 3 months for histological examination with HE staining.</p><p><b>RESULTS</b>The labeled cells showed stable GFP expression both in vitro and in vivo. One week after cell injection, green fluorescence signals were detected by the in vivo fluorescence imaging system in the lower back of the mice, and at 4 weeks, the fluorescent tumor mass increased with a bone metastasis rate of 19% (3/16). Dissection of the mice at 3 months revealed lumbar tumor infiltration in 3 mice, showing a consistent result with in vivo fluorescence imaging.</p><p><b>CONCLUSION</b>The nude mouse model of spinal bone metastasis of human prostate cancer established using GFP-labeled PC-3 cells facilitates further study of bone metastasis of prostate cancer.</p>
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Animals , Humans , Male , Mice , Cell Line, Tumor , Disease Models, Animal , Green Fluorescent Proteins , Mice, Inbred BALB C , Mice, Nude , Neoplasm Metastasis , Prostatic Neoplasms , Pathology , Spinal NeoplasmsABSTRACT
BACKGROUND: The standardized treatment for patients who require total hip replacement is the implantation of an intramedullary diaphyseal anchored hip prosthesis. A bone-sparing non-stemmed hip prosthesis (NSHP) can be used as an alternative device for young patients. The NSHP relies on proximal femoral metaphyseal and neck fixation. The theoretic advantage of leaving diaphyseal bone intact is easier conversion to a stemmed prosthesis. On the other hand,clinical investigations published reported THR had high loosening rate of the prosthesis, which greatly limits its long-term clinical results; the aim of NSHP is to give the femoral prothesis a kind of biological fixation to decrease the loosening rate of the prosthesis. This retrospective study evaluated the medium- and short-term results after total joint replacement using NSHP.OBJECTIVE: To evaluate the outcome of NSHP for the treatment of young patients with hip disorders.DESIGN: Case analysis.SETTING: Department of Orthopaedics, the First Affiliated Hospital of Guangxi Medical University.PARTICIPANTS: Fifteen patients (17 hips) with hip disorders, who were treated at the Department of Orthopaedics,First Affiliated Hospital of Guangxi Medical University between 2001 and 2005, were retrieved. The involved patients included 8 males and 7 females. They were aged (37.8±9.8) years ranging from 21 to 49 years when they underwent operation. Indications for implantation included avascular necrosis (7 hips), posttraumatic osteoarthritis(4 hips), primary osteoarthritis(3 hips), osteoarthritis secondary to dysplasia(3 hips). Informed consents were obtained from all the patients before operation. The neotype of non-stemmed hip prosthesis (NSHP) was made of Co-Cr-Mo casting alloy with good biocompatibility by Shanghai Fusheng Medical Equipment Co., Ltd (Guoyao guanxie (shi) No. 2002-3040397; Guoshi Yaojianxie(zhun) No. 2005-3460799).METHODS: Fifteen patients (17 hips) with hip diseases subjected to the replacement of total hip with NSHP. Patients were followed-up once every other 6 months in the postoperative first year, then once every year, 5 years in total. The follow-up visit included functional evaluation and X-ray evaluation. ① Functional evaluation: Evaluative criteria of Harris joint function scale were adopted: full marks (point) =100, ≥ 80 excellent, ≥ 60 good, 40 fair and ＜ 40 poor; The following clinical data were documented: relief of pain, ability to lie on the operated side, additional procedures, use of pain medication, postoperative hip dislocations and so on. Pain was evaluated by using visual analogue scale (VAS),which ranged from 0 (no pain) to 10 (worst possible pain). ② X-ray evaluation: A standardized radiographic assessment was performed using an anteroposterior view of the pelvis. The following radiological data were recorded: preoperative grade of osteoarthritis as classified according to the method from Busse et al, preoperative grade of femoral head necrosis as classified according to the method from Ficat et al, inclination angle of the operated and the untreated side,radiolucencies according to the method of Buergi et al, heterotopic ossifications, as classified according to the method of Brooker et al. Postoperative adverse events and complications were observed and revision operation was needed if necessary.MAIN OUTCOME MEASURES: Correlative conditions of patients who were followed up for 5 years: ① Inserting angle of prothesis and the collodiaphyseal angle in the opposite side. ②Radiolucency and heterotopic ossification classification.③preoperative osteoarthritis classification, preoperative avascular necrosis of femoral head classification. ④ Revision operation, adverse events and complications. ⑤ Postoperative functional evaluation: Relief of pain (Harris joint function score), ability to lie on the operated side, additional procedures, use of pain medication, postoperative hip dislocations and VAS results.RESULTS: Fifteen patients were involved. One patient was lost after 3-month treatment and the other patients were followed up for 5 years. ① Postoperative functional evaluation results of patients. In the postoperative 5-year follow-up visit, hip joints of 13 patients (15 hips) were still in situ, pain lessened or disappeared in 11 patients (84.6% ,11/13),12 patients(92.3%, 12/13) would undergo the procedure again, 10 patients (76.9%, 10/13) were able to lie on the operated side; The average of Harris hip score was (72±19.6). The average Harris hip score did not vary significantly between the different diagnosis groups (P ＞ 0.05). Postoperative VAS was 2.6±2.2 on average. There was no significant difference in the hip joint pain among different diagnosis groups (P ＞ 0.05); Nine patients required no pain medication (69.2%,9/13).Two patients (15.4% ,2/13) occasionally took nonsteroidal anti-inflammatory drugs and two patients (15.4% ,2/13) took nonsteroidal anti-inflammatory drugs on a regular basis. ② X-ray evaluation results of patients: Preoperative osteoarthristis classification: One hip had grade 1 joint degeneration, 3 hips had grade 2 joint degeneration and 6 hips had grade 3 degeneration. Preoperative avascular necrosis of femoral head classification: Out of 7 patients with avascularnecrosis of femoral head, 4 patients had stage 3 femoral head necrosis, and 3 patients had stage 4 femoral head necrosis. In the postoperative 5-year follow up, 1 patient had radiolucency. Because the range of radiolucency was very small, progression was not quick and clinical symptoms were not severe, so revision operation was not conducted;In the postoperative 6th month, the inclination angle averaged (135.2±6.8)° on the untreated side and (132.2±6.5)° on the treat side. One patient with congenital hip dysplasia and a previous varus derotational osteotomy had a postoperative inclination angle below 120°. Patients with postoperative inclination angles between 125° and 140° had significantly less hip pain than the rest of the series. Heterotopic ossifications classification: Three patients had postoperative heterotopic ossifications, one hip had grade 1 heterotopic ossification, 1 hip had grade 2 heterotopic ossification, and 1 hip had grade 3 heterotopic ossification.③ Revision operation: one patient (5.9%,1/17)required a revision total hip arthroplasty due to pain. Good bone stock of the proximal femur was found in the patient which allowed implantation of a conventional medullary anchored prosthesis. This revision surgery and postoperative rehabilitation were uncomplicated.④ Adverse events and complications: Hip dislocation occurred postoperatively in one patient (5.9%,1/17). Other complications included trochanter bursitis (n=1), fistula (n =1), and seroma (n =1).CONCLUSION: ① NSHP provides biological fixation for femoral prothesis by bone proliferation through the windows with connective tissues surrounding the prothesis and has the characteristics of low stress and deformation, high intensity and rigidity, and anti-loosening, thus, may prolong its live lime. ②Revision surgeries are facilitated by the good bone stock remaining in the proximal femur. ③ The short- and medium-term therapeutic effects of total hip arthroplasty are satisfying in young patients.
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BACKGROUND:The factors to affect spinal fusion are suitable bone graft location,good graft bed,enough bone grafts,strict fixation measure and enough fixation time. However,it is unclear which method should be used between intervertebral bone grafting and intertransverse bone grafting,as well as which material should be used between autogenous iliac bone and autogenous spinous process and vertebral lamina of resection. OBJECTIVE:To compare the fusion rate and improvement of clinical symptoms among different bone graft materials and methods which used in bone fusion for lumbar spondylolisthesis. DESIGN:A control observational experiment. PARTICIP ANTS:A total of 92 patients with lumbar spondylolisthesis who received bone fusion treatment. According to Meyerding classificantion,there were 50 cases of degree Ⅰ,40 cases of degree Ⅱ,1 case of degree Ⅲ,and 1 case of degree Ⅳ. There were 1 case in L3,58 cases in L4,and 33 cases in L5. METHODS:All patients received spinal canal decompression. After reduction and fixation was performed by spondylolisthesis reduction system(SRS) ,bone grafting fusion was performed in all patients. They were divided into four groups:autogenous spinous process and vertebral lamina graft placed between transverse processes group(n=21) ,autogenous spinous process and vertebral lamina graft placed between the vertebral bodies group(n=27) ,autogenous iliac bone graft placed between transverse processes group(n=21) ,autogenous iliac bone graft placed between the vertebral bodies group(n=23) . MAIN OUTCOME MEASURES:The fusion rate and the improvement of clinical symptoms were evaluated according to the X-ray pre and post operative,as well as the JOA score. RESULTS:At 6 months after operation,the fusion rate in the autogenous iliac bone graft placed between the vertebral bodies group were significantly higher than that in the other three groups(P 0.05) . According to the JOA score,at 6,9,and 12 months after operation,there were no differences in the score among the four groups. CONCLUSION:Posterior bone graft fusion of the vertebral body or transverse process using the vertebral lamina,spinous process,or iliac bone as autograft along with internal fixation for lumbar spondylolisthesis are effective. However the use of the iliac bone as autograft contributes to a higher fusion rate in the same method at 6 months. Further using the same material as autograft,the fusion rate of the autograft placed between vertebral bodies is better than that of the autograft placed between transverse processes at 6 months.
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Objective To discuss the teaching effects of PBL teaching mode applied in clinical practice of bone surgery.Methods Through clinical practice of bone surgery with the PBL teaching mode and the traditional one,a contrast between two teaching modes was made,and the teaching results were investigated base on the questionair.Results The PBL teaching mode is superior to the traditional one.Conclusion The PBL teaching mode has an obvious advantage in the teaching of clinical practice of bone surgery and can improve the teaching quality.
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Objective To summarize the surgical techniques to treat complex stale acetabular fractures through combined approaches. Methods From February 1993 to September 2005, 21 cases (12 males, 9 females, mean age of 33 years old) of complex stale acetabular fracture were treated with open reduction and internal fixation through combined approaches (K- L+ ilio- inguinal). Of the 21 fractures, 3 were transverse and posterior wall ones, 4 T- shaped ones, 11 both column ones, and 3 hemi- transverse and anterior column ones. Results 12 cases (57.1% ) got anatomic reduction, 5 cases satisfactory reduction (23.8% ), but 4 cases unsatisfactory reduction (19.1% ). The rates of anatomic reduction for the early 6 years and for the latest 6 years in this study were 44.4% and 66.7% respectively. 15 cases were followed up for 2 to 12 years. The excellent and good rate for clinical and roentgenographic results were 65.3% and 67.2% respectively. The clinical results for anatomic and non- anatomic reduction groups were 78.6% and 32.8% respectively (P
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Objective To investigate the anatomic relationship between the upper thoracic vertebrae and adjacent structures in anterior approach of upper thoracic spine, an anatomy study was conducted and its clinical significance was evaluated. Methods Twenty upper thoracic spine specimens of adult human cadaver were exposed, measured and studied for their anatomic landmarks. The origin, course of the recurrent laryngeal nerve, thoracic duct and blood vessels and their relationship were measured and analyzed. The advantages and disadvantages of different surgical approaches exposing the upper thoracic vertebrae were also evaluated and compared. Results The right recurrent laryngeal nerve reaches the tracheo-esophageal groove at the level of C6-7 disc in 55% of the specimens and derives from vagus nerve at the level of T1,2. The thoracic duct empties into the systemic venous system from T1 to T1-2 disc space in 75% of the specimens and among them, more than 50% up to T1 level. The left brachiocephalic vein is at T3 in 55% of the specimens; and the aortic arch is at T3-4 disc in 80% of the specimens. The anterior aspect of T3 can be easily exposed through a modified anterior approach to the upper thoracic vertebrae in only 45% of the specimens(9), compared with outside space of the brachiocephalic trunk(between the right brachiocephalic vein and the brachiocephalic trunk and left brachiocephalic vein) in 95% of the specimens (19). Conclusion Surgical approach through outside space of the brachiocephalic trunk is simple and adequate to expose the T3,4 vertebra body and can get more exposed space of 0.5-1 of the vertebra body than through inner space of the brachiocephalic trunk and can be utilized selectively during anterior upper thoracic spine surgery. Attention should be paid to avoid injury of vagus nerve in the middle, right recurrent laryngeal nerve on the right and thoracic duct on the left, respectively.
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Objective To study the operation methods and efficacy of joint prosthesis with artificial diaphysis for the treatment of tumors at the end of bone. Methods 28 patients with tumors at the end of bone had resection and limb salvage by joint prosthesis with artificial diaphysis. These cases consisted of 11 osteosarcomas, 10 bone giant cell tumors, 2 chondrosarcomas, 2 metastatic carcinomas, 1 malignant fibrous histiocytoma,1 aneurysmal bone cyst and 1 osteochondroma. Among them, there were 7 cases of proximal femoral tumors, 6 cases of distal femoral tumors, 10 cases of proximal tibial tumors, 5 cases of proximal humeral tumors. Results The follow-up periods were 16 months to 15 years. Eighteen patients died. Functional activity was satisfactory in 71% of the patients(2 years). Conclusions Joint prosthesis with artificial diaphysis for the treatment of tumors at the end of bone is feasible, and a better system for reattachment of the soft tissues is needed to avoid pain and a persistent limp.
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Objective To investigate the procedure of anterior thoracic corpectomy and the surgical outcomes of upper thoracic spine tumors by the right space of the ascending aorta and the right space of the brachiocephalic artery. Methods 12 patients underwent surgery between June 2000 and January 2006. There were 8 cases of primary tumors and 4 metastatic carcinomas, 4 cases of tumor in T3 and 6 cases in T4 and 3 cases in T3,4. The anterior modified transmanubrium approach was made. After the exposure of the tumor through the right space of the ascending aorta and the right space of the brachiocephalic artery, the involved vertebral body and contiguous discs were resected, the spinal cord was decompressed. Curettage was performed in 3 cases for other tumors, en bloc vertebrectomies were performed. As a body replacement, in case of benign disease autogenous bone graft harvested from the dorsal iliac crest was used, and for malignant bone tumors using bone cement. To secure the strut, anterior cervical titanium alloy plates were used until T5. Neurological status was graded according to Frankel grading system. Results 6 cases of bradycardia and hypotension or increasing airway resistance occurred intraoperatively. The mean follow-up period was 28.6 months (range 4-66 months). 3 patients with autogenous bone graft had bone union 6 months postoperatively. According to Frankel grading system, 1 patient improved from grade A preoperation to B postoperation, while another patient from B to C; of the 5 cases with grade C preoperation, 4 patients improved to D postoperation and 1 patient to E; 4 patients improved from D to E; 1 patient with grade E left unchanged. 3 patients died from general metastasis and failure 10-20 months postoperatively. One patient with giant cell tumor recurred 10 months postoperatively. Conclusion Clear exposure and satisfactory outcome can be obtained by the use of the right space of the ascending aorta and the right space of the brachiocephalic artery; it is especially indicated to the upper thoracic spine T3 and T4 tumors, where the spinal compression is located anteriorly.
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Objective To evaluate the short and middle-term outcome of metal surface hemiarthroplasty in treatment of femoral head osteonecrosis. Methods Forty-one patients (forty-eight hips) with average age of 40 years were performed hemi-arthroplasties and followed up for minimum 3 years. Thirty-five cases were at the stage of Ficat Ⅲand 13 at the stage Ⅳ and their acetabular were relatively normal. Measurements of the hip reconstruction were made on the anteroposterior pelvic radiograph assisted with computer. The outcome of metal surface hemi-arthroplasty and the correlation between the orientation of the femoral component and the migration of implant was evaluated. Results The mean duration of follow-up was 5.2 years. The average UCLA hip score was improved significantly (P