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BACKGROUND:Transforming growth factor β1 (TGF-β1) and interleukin 1β (IL-1β) have been reported to play an important role in the occurrence and development of primary osteoarthritis. OBJECTIVE:To investigate the association between gene polymorphisms of TGF-β1 and IL-1β and primary knee osteoarthritis. METHODS: Han and Uyghur elderly populations in Xinjiang Uygur Autonomous Region, China were surveyed on the prevalence of osteoarthritis, followed by allotted to osteoarthritis and health groups according the symptoms and radiography. Genotyping TGF-β1-509C/T and -1348C/T and IL-1β-511C/T was performed to analyze the relationship between the gene polymorphisms of TGF-β1 and IL-1β and osteoarthritis. RESULTS AND CONCLUSION:Alleles T and C with genotypes CC, CT and TT were detected in both two groups. In the Uygur population, the genotype frequency of TGF-β1-509C/T and IL-1β-511C/T showed significant difference between osteoarthritis and health groups (P < 0.05). In the Han population, the genotype frequency of TGF-β1-1348C/T showed significant difference between two groups (P < 0.05). These results suggest that the Uygur individuals carrying TT genotype of TGF-β1-509C/T and IL-1β-511C/T, and Han people carrying the TT genotype of TGF-β -1348T are more susceptible to osteoarthritis.
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Objective:To study the construction of matrix metalloproteinase 3 (MMP3)biosensor vector,and to illuminate the activated process of MMP3 in the living cells.Methods:The ECFP-MMP3-YPet biosensor vector anchored on cellular surface was constructed and identified.The MMP3 biosensor was transfected into the 293T cells.The transfection efficiency was observed 24 h after transfection.The flurorescence resonance energy transfer (FRET )-based MMP3 biosensor was observed by inversion fluorescence microscope. Results:The MMP3 biosensor vector was successfully constructed.The length of MMP3-YPet identified by double enzyme digestion and PCR was about 780 bp.The transfection efficiency of MMP3 biosensor was about 40%,and which was evenly presented in cytoplasm of 293T cells.And the FRET ratio of MMP3 biosensor was decreased after stimulation with uPA on the 293T cells. The FRET ratio reached its minimum about 30 min later. Conclusion:The MMP3 biosensor can sensitively and reliably monitor the MMP3 activation in living cells.
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Objective To investigate the factors that affecting the efficacy of arthroscopic debridement in the treatment of knee osteoar-thritis. Methods The clinical data of patients with knee osteoarthritis treated with arthroscopic debridement in our hospital from January 2009 to December 2013 was retrospectively analyzed,and the treatment effect was evaluated by Lysholm score. The factors that may affect the efficacy were selected to make a single factor analysis,and then made a multiple logistic regression analysis with the factors which were of sta-tistical significance through single factor analysis. Results Single factor analysis showed that age,course of disease,body mass index,psycho-logical factor,preoperative VAS score,preoperative Kellgren-Lawrence grade,preoperative Lysholm score and postoperative rehabilitation exer-cise were the factors that affected the efficacy of knee arthroscopy in the treatment of knee osteoarthritis,and the difference between the two groups was statistically significant. Further multivariate analysis showed that high body mass index,high preoperative VAS pain score,low Ly-sholm score,high psychological expectations and high preoperative Kellgren-Lawrence grading were expected to be the independent risk fac-tors of knee arthroscopy in the treatment of knee osteoarthritis. Strict compliance with the postoperative rehabilitation exercise was the protect factor. Conclusion High body mass index,high preoperative VAS pain score,low preoperative Lysholm score,high preoperative Kellgren-Lawrence grading,and high psychological expectations were expected to reduce the effect of surgery,while strict compliance with the postoper-ative rehabilitation exercise can improve the curative effect.
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Objective To investigate the incidence of surgical site infection (SSI)in patients undergoing orthopedic surgery,analyze the risk factors,and provide basis for the prevention and control of SSI.Methods All hospitalized orthopedic patients undergoing surgery in a hospital from January 2010 to December 2014 were retrospectively sur-veyed,questionnaires were designed,patients’medical records were reviewed,incidence of SSI was analyzed,risk factors for SSI were analyzed with univariate and logistic regression methods.Results A total of 14 300 orthopedic patients undergoing surgery were investigated,576 (4.03%)patients had SSI,predominantly were superficial inci-sion infection (n=429,74.48%),615 strains of pathogenic bacteria were isolated from 576 patients,mainly were Staphylococcus aureus (n=137,22.28%),Escherichia coli (n=84,13.66%),and Enterobacter cloacae (n=73, 11 .87%).The incidence of SSI decreased year by year in patients undergoing orthopedics surgery(χ2 =24.706,P <0.001);the incidence of SSI in patients with amputation was the highest (22.67%),followed by patients with de-bridement (7.16%);multivariate logistic regression analysis indicated that long duration of operation,long length of hospital stay,underlying diseases,use of implants,contaminated incision,more intraoperative blood loss,irra-tional perioperative use of antimicrobial agents,and without using negative pressure drainage were independent risk factors for SSI in patients undergoing orthopedic surgery.Conclusion The incidence of SSI is high in orthopedic pa-tients undergoing surgery,effective preventive measures should be actively taken according to the related risk factors of SSI,so as to reduce the occurrence of SSI.
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Objective To compare the effectiveness and safety of tranexamic acid and fibrin sealant in joint arthroplasty . Methods The literatures on the application of tranexamic acid and fibrin sealant in joint arthroplasty were retrieved from PubMed , Embase ,Cochrane Library ,CNKI and other internet databases .Two reviewers independently screened the literatures according to the inclusion and exclusion standard .The RevMan 5 .2 software was adopted to conduct the statistical analysis on the extracted da‐ta .Results Four randomized controlled trials(RCTs) and 2 retrospective experiments were included ,involving 449 patients .The meta analysis results showed that tranexamic acid and fibrin sealant had no statistically significant difference in total blood loss[MD= -192 .24 ,95% CI(-496 .16 ,111 .69) ,P=0 .22] and hemoglobin loss amount[MD= -0 .49 ,95% CI(-1 .19 ,0 .20) ,P=0 .16] , had statistically significant difference in the blood transfusion rate[OR=0 .30 ,95% CI(0 .18 ,0 .52) ,P<0 .01] ,and had no statisti‐cally significant difference in the postoperative complications[OR=1 .20 ,95% CI(0 .36 ,3 .99) ,P=0 .76] .Conclusion Tranexamic acid is more effective than fibrin sealant of controlling postoperative transfusion rate in joint arthroplasty .
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Objective To construct the eukaryotic expression vector urokinase-type plasminogen activator (uPA) biosensor which was the composition of the fusion protein enhanced cyan fluorescent protein-uPA (substrate)-yellow fluorescent protein variant (ECFP-uPA substrate-linker-YPet).Methods By the template Src-biosensor, the YPet primers were designed by Primer Premier 5.0 software,and the restriction enzyme sites,uPA substrate gene sequence and linker were added in its 5′ end. With the intermediate vector pDMTM-18T, an eukaryotic expression vector which contained a fusion protein of ECFP-uPA substrate-linker-YPet was constructed by genetic engineering.Then the uPA biosensor was transfected into 293T cells.The transfection efficiency and expression of fusion proteins were observed after 24 h.Fluorescence resonance energy transfer (FRET)was observed by the inversion fluorescence microscope and measured by the MetaFlour FRET 4.6 software. Results The uPA biosensor vector was confirmed by the fragment of PCR and double restriction enzyme digestion.The transfection efficiency was nearly 40%.The immunofluorescence detection results displayed that uPA biosensor fusion protein expressed in the 293T cells membrane and the FRET of uPA biosensor in the living 293T cells was observed after incubation with the recombinant human uPA (rhuPA).Conclusion uPA biosensor is successfully constructed and it could be used as a molecular probe to study the temporal and spatial variation of uPA in living cells.
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Objective To explore the clinical efficacy of polyetheretherketone( PEEK) cages and titanium cages combined with pedicle screw fixation operation in treatment of lumbar degenerative disease,and provide reference for clinic. Methods The data of 50 patients with lumbar degenerative disease in our hospital from March 2011 to March 2013 were retrospectively analyzed. All patients were treated with pos-terior decompression,bone graft and transpedicular screw internal fixation,according to the different cages,they were divided into PEEK group and titanium group. The PEEK group with 25 patients used polyetheretherketone cages,and the titanium group with 25 patients used titanium cages. The JOA scores of patient before surgery,1 month,6 months and 1 year after surgery between two groups were recorded and compared. The ROM of fusion levels and adjacent segment of patients before and after operation between two groups were compared. Results There was no statistical significance of difference in JOA score,Oswestry score and fusion rate between two groups(P>0. 05). There were statistical significance of differences intervertebral disc height change between 2 groups(P<0. 05). The ROM of fusion levels and adjacent segment of patients in PEEK group was better than those in titanium group(P<0. 05). Conclusion The polyetheretherketone cages combined with pedicle screw fixation operation have a good effect in the treatment of patients with lumbar degenerative disease,especially in matter of lumbar spinal motion and intervertebral height lost.
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Objective To compare the effects of sodium hyaluronate (SH) and celecoxib (CO) administration on the treatment of knee osteoarthritis (OA) and to investigate their influences on levels of uPA and MMP-3 in synovial fluid. Methods One hundred and thirty-six knee osteoarthritis (OA) patients from January 2010 to October 2011 were randomly enrolled into two groups: the SH group and the CO group. In the SH group, patients were injected with 2 mL sodium hyaluronate intra articulation once a week for 5 weeks. In the CO group , patients were given oral administration of celecoxib daily at a dosage of 200 mg for 5 weeks. Before and at 1 ,6 months after treatment, Lequesne′s index and VAS-pain were detected to assess the clinical results of these two drugs. The levels of uPA and MMP-3 in synovial fluid were measured by using ELISA assay. Results All patients were followed up for 6 months to 12 months. The Lequesne′s index and VAS-pain score were lowered at 1 and 6 moths after treatment in both the SH group and the CO group(P0.05). Dramatic reduction of the levels of uPA and MMP-3 in synovial fluid were observed in the SH group after treatment(P0.05). Conclusion The redueced levels of uPA and MMP-3 in synovial fluid after treatment of sodium hyaluronate may contribute to its longer-lasting effect than that of celecoxib. Therefore , the combination of sodium hyaluronate with celecoxib may lead to better therapeutic effect on OA patients.
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Objective To investigate the expression and significance of MMP-3 in knee joint synovium of different stage in osteoarthritis (OA) patients. Methods MMP-3 protein were detected by immunohistochemical method in knee synovial tissues from 90 OA patients (the OA group) and OA group was divided into 3 subgroups according to Kellgren and LawrenceX-ray diagnosing standards: the gradeⅠ(n = 30), gradeⅡ (n = 30) and grade Ⅲ subgroups (n = 30). 30 patients were enrolled as control group. Immunohistochemistry was used to detect the expression of MMP-3 protein in the tissue. Results The expression level of MMP-3 protein in OA group was significantly higher that in the normal synovium (P < 0.05). There existed significant difference in the expression of MMP-3 protein between the grade Ⅲ subgroup and the gradeⅠ, or Ⅱsubgroups (P < 0.05). The expression of MMP-3 protein related positively to the severity of OA (r = 0.912, P < 0.05). Conclusion The expression of MMP-3 protein related closely to the pathogenic mechanism of OA. It may serve as an important indicator of early diagnosis and the activity of OA.
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Objective To evaluate the expression and clinical significance of matrix metalloproteinase 14(MMP-14) in osteoar-thritis(OA) patients in synovium and synovial fluid of knee joint .Methods Semi-quantitative RT-PCR were used to detect the ex-pression of MMP-14 mRNA in 32 case of OA (experimental group)and 26 non-OA patients(control group)synovium ;protein level expression of MMP-14 in synovial fluid were analyzed by ELISA .Results The expression of MMP-14 mRNA in experimental group synovium of knee joint was significantly increased compared with control group (P<0 .05);but the protein level of MMP-14 was low in experimental group synovial fluid compared with control group (P<0 .05) .Conclusion The expression of MMP-14 is increased in OA patients synovium and maybe promote the progress of OA directly ;the protein level of MMP-14 is decreased in OA synovial fluid ,indicated the function of MMP-14 in OA synoviocyte indirectly .
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Objective To detect the expression levels of urokinase-type plasminogen activator (uPA), matrix metalloproteinase-3 (MMP-3),MMP-9,MMP-13 and MMP-14 in the patients with osteoarthritis(OA)before and after arthroscopic debridement,and to explore the influence of arthroscopic debridement in the expressions of uPA, MMP-3,MMP-9,MMP-13, and MMP-14.Methods 420 cases of synovial fluid from knee OA patients undergoing arthroscopic debridement were obtained before operation. After six months follow-up, 350 cases of synovial fluid samples were obtained and according to inclusion and exclusion criteria, 228 synovial fluid were selected to analyze.The expression levels of uPA,MMP-3,MMP-9,MMP-13,and MMP-14 were measured by ELISA assay.Pain intensity of these patients before operation and six months after operation were recorded using the Visual Analogue Scale/Score(VAS).The differences of the expression levels of uPA,MMP-3,MMP-9, MMP-13,and MMP-14 between before operation and after operation were compared.The relationship between the expression levels of uPA, and MMP-3, MMP-9, MMP-13, MMP-14 and VAS was analyzed with Spearman analysis.Results All the patients were followed up for 36.5 months. Compared with before operation, the expression levels of uPA and MMP-3 in the synovial fluid of the patients after arthroscopic debridement were significantly decreased(P<0.01),the expression levels of MMP-9 and MMP-13 were also decreased (P<0.05), but the MMP-14 expression level showed no significant change.The expression levels of uPA,MMP-3,MMP-9, MMP-13,MMP-14 were positively associated with VAS before arthroscopic debridement (r=0.361,r=0.417, r=0.136,r=0.514,r=0.156,P<0.05 );uPA and MMP-3 were positively correlated with VAS after arthroscopic debridement(r=0.981,r=0.831,P<0.01),as well as the expression level of MMP-13 and VAS, but there were no significant differences between the expression levels of MMP-9, MMP-14 and VAS. Conclusion The decreased levels of uPA,MMP-3 and MMP-13 in synovial fluid may contribute to the pain-relief effects of arthroscopic debridement.
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[Objective]To investigate the effects of doxycycline on rabbit immobilized osteoarthritis and their mechanism.[Method]Twenty-four rabbits were randomly divided into normal,model,control and treatment groups,with 6 rabbits in each group.All of the animals were immobilized the lower left limbs with plaster bandage for 4 weeks except normal group.Doxycycline was orally given to treatment group.Cartilage degeneration of the medial condyle of femur was observed at 4 weeks and the levels of collagen-Ⅱ,uPA and MMP-13 were tested.[Result]Cartilage degeneration in treatment group was significantly slighter than those in model and control groups.Data of collagen-Ⅱ,uPA and MMP-13 between model and control groups had no significant difference,but a noticeable statistical difference among other groups.The uPA activity was positively correlated with MMP-13.[Conclusion]Doxycycline inhibits the degeneration process of cartilage and improves the structure.The effects may be related to the inhibition of uPA and MMP-13.
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[Objective]To study the role and the effect of establishing the plan of meeting emergency in the rehabilitation and reestablishment of high-octane body hurt.[Method]Eighty six patients of high-octane body hurt were collected from Shi He Zi people's hospital during 1998 to 2007.According to Gustilo-Anderson categorize of open fracture and mark of ISS,high-octane body hurt can be divided into three parts.Meanwhile,different part can be taken different methods to rehabilitate and reestablish.Therefore,we can analyze pertinence between cure principle and curative effect.[Result]Eighty three patients were observed during the period of fifteen and thirty-three months,the average were nineteen months.Five of them contracted double floating knee injury,and their knee joint appeared anchylosis,abnormality and function failure afterfracture healed up.We did one-off knee joint release while extracting internal fixation,and used CPM machine to assist exercise.Fortunately,the function of knee joint could be renewed.Another five patients' fracture did not heal up very well.However,after experiencing the apply of oneself bone autograft,fracture could be healed up perfectly.The time of allograft bone union ranged from five to sixteen months,the average time were 7.5 months.There are three patients contract paraplegia,and three patients dead.By autopsy,some of them belongs to multiple fracture and multiple viscera burst.Mortality was 3.48%.[Conclusion]By establishing the plan of meeting emergency of high-octane body hurt,using the Gustilo-Anderson categorize of open fracture and mark of ISS,we can systemic classify damage degree,and make scientific treatment by stages,therefore,attaining our goal of early diagnoses,early treatment,and decreasing mortality and decreasing the proportion of disabled.After all,the plan of meeting emergency plays an essential role in traumatie surgery.
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[Objective]To observe complications of tibial pilon fractures with Ⅲ leaves type plate and analysis of causes and prevention of complications.[Method]Fourty-two cases of the final pilon fractures were treated with Ⅲ leaves type plate from July 1999 to December 2003.There were 30 males and 12 females,the average age was 45.3 years(ranged,15～62 years),9 cases were open fracture and 33 cases were open fracture.According to the Ruedi-Allgower classification,there were 15 cases of type Ⅰ fracture,18 cases of type Ⅱ fracture and 9 cases of type Ⅲ fracture.[Result]Fourty-two cases were followed up for an average of 28 months(ranged,14～60 months),The time to fracture union averaged 16 weeks(ranged,11～26 weeks).The complications included infection in 6 cases,cases with severe traumatic arthritis and 3 cases with ankylosis.After evaluated according to the criteria of Bourne,there were 19 cases assessed as being excellent,17 as good and 2 as poor,the excellent and good rate was 85.7%.[Conclusion]Ⅲ leaves type plate is a good internal fixation for tibial pilon fractures,but the complications should be prevented.
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The application of network and multimedia technology in combination with bilingual teaching in orthopedics is explored which not only promotes the use of multimedia technology in teaching,but also enhances students' understanding ability for professional knowledge.Moreover,it can enhance students' learning interest in medical English and medical knowledge,thus promoting education effectively.
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Objective To explore whether or not the cartilage damage in the pathogenesis of pathologic synovial plicae is due to the matrix metalloproteinase. Methods The immunohistochemical method was used to detect the expression and distribution of matrix metalloproteinase-1(MMP-1) and tissue inhibitor of metalloproteinase-1(TIMP-1) in arthroscopically clarified pathologic synovial plicae and normal synovial plicae of the knee joint.Results The positive expression rate of MMP-1 and TIMP-1 had significant differences between the pathologic and normal synovial plicae(?~2=16.014,P=0.000;?~2=4.059,P=0.044).The expression of MMP-1 was positive in the synovial lining cells,monocytes,lymphocytes,endothelial cells,and chondrocytes,but negative in the normal synovial plicae.The TIMP-1 expression was only detected in the synovial lining cells and a small quantity of fibroblast cells.The immunohistochemical analysis revealed a greater number of positive cells and intensity of staining of MMP-1 than TIMP-1.Conclusions The development of pathologic synovial plicae may yield MMP-1 and TIMP-1 with unbalanced distributions,which may be the biological basis of the pathogenesis of cartilage destruction.
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Evidence-based medicine(EBM)is a new mode for modern medical education in orthopaedic teaching.The theory of evidence-based medicine is an essential part of clinical education for young doctors in practice,which improves their ability of thinking,scientific research and self-education,so as to enhance the students'comprehensive ability and lay sound basis for medical practice in future.
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Objective To summarize countermeasures on common problems of microendoscopic discectomy(MED). Methods Microendoscopic discectomy was performed in 104 cases of lumbar disc herniation by using the MED system(Sofamor Danek Group,USA).Frequently encountered problems during the operation were reviewed and summarized. Results Conversions to open surgery were required in 4 out of 104 cases due to bleeding or adherence.Among the rest of 100 cases,dural injury occurred in 3 cases,with 1 case accompanying leakage of cerebrospinal fluid.Of the 100 cases(115 intervertebral spaces),the average operation time was 50 min(range,30~90 min) and the average hemorrhage amount was 80 ml(range,20~400 ml) for each intervertebral space.The 100 cases were followed for 3~32 months(average,18 months).According to the Macnab criteria,the curative effects were classified as excellent in 65 cases,good in 29 cases,and fair in 6,the rate of excellent or good effects being 94.0%(94/100). Conclusions The most frequent problems during MED are bleeding and prolonged excision of the ligamenta flava.Strict adherence to technique,acquaintance with the weakness of the ligamenta flava,and familiarity with anatomic structures of the vertebral vein system and its relationship with abdominal pressure,are very important in the prevention and treatments of surgical complications.