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Infectious bone defect is bone defect with infection or as a result of treatment of bone infection. It requires surgical intervention, and the treatment processes are complex and long, which include bone infection control,bone defect repair and even complex soft tissue reconstructions in some cases. Failure to achieve the goals in any step may lead to the failure of the overall treatment. Therefore, infectious bone defect has been a worldwide challenge in the field of orthopedics. Conventionally, sequestrectomy, bone grafting, bone transport, and systemic/local antibiotic treatment are standard therapies. Radical debridement remains one of the cornerstones for the management of bone infection. However, the scale of debridement and the timing and method of bone defect reconstruction remain controversial. With the clinical application of induced membrane technique, effective infection control and rapid bone reconstruction have been achieved in the management of infectious bone defect. The induced membrane technique has attracted more interests and attention, but the lack of understanding the basic principles of infection control and technical details may hamper the clinical outcomes of induced membrane technique and complications can possibly occur. Therefore, the Chinese Orthopedic Association organized domestic orthopedic experts to formulate An evidence-based clinical guideline for the treatment of infectious bone defect with induced membrane technique ( version 2023) according to the evidence-based method and put forward recommendations on infectious bone defect from the aspects of precise diagnosis, preoperative evaluation, operation procedure, postoperative management and rehabilitation, so as to provide useful references for the treatment of infectious bone defect with induced membrane technique.
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Bone defects caused by different causes such as trauma, severe bone infection and other factors are common in clinic and difficult to treat. Usually, bone substitutes are required for repair. Current bone grafting materials used clinically include autologous bones, allogeneic bones, xenografts, and synthetic materials, etc. Other than autologous bones, the major hurdles of rest bone grafts have various degrees of poor biological activity and lack of active ingredients to provide osteogenic impetus. Bone marrow contains various components such as stem cells and bioactive factors, which are contributive to osteogenesis. In response, the technique of bone marrow enrichment, based on the efficient utilization of components within bone marrow, has been risen, aiming to extract osteogenic cells and factors from bone marrow of patients and incorporate them into 3D scaffolds for fabricating bone grafts with high osteoinductivity. However, the scientific guidance and application specification are lacked with regard to the clinical scope, approach, safety and effectiveness. In this context, under the organization of Chinese Orthopedic Association, the Expert consensus for the clinical application of autologous bone marrow enrichment technique for bone repair ( version 2023) is formulated based on the evidence-based medicine. The consensus covers the topics of the characteristics, range of application, safety and application notes of the technique of autologous bone marrow enrichment and proposes corresponding recommendations, hoping to provide better guidance for clinical practice of the technique.
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Objective:To investigate the factors for and prevention of muscular calf vein thrombosis (MCVT) after unilateral total knee arthroplasty (TKA).Methods:Between January 2018 and October 2020, 551 patients were admitted to Department of Orthopedics, The First Affiliated Hospital to Zhengzhou University for unilateral TKA. They were 187 males and 364 females, aged from 32 to 90 years (average, 64.6 years) and with 234 left and 317 right knees affected. They were assigned into a MCVT group ( n=77) and a non-MCVT group ( n=474) according to whether or not MCVT had happened at 7 days after operation. Recorded were the patients’ baseline information, tourniquet time, intraoperative blood loss, postoperative prothrombin time (PT), postoperative thrombin time (TT), postoperative fibrinogen (FIB), D-dimer, platelet count (PLT), postoperative bed time, knee society score (KSS), erythrocyte sedimentation rate (ESR) fall time, and C-reactive protein (CRP) fall time so as to analyze the risk factors for MCVT. Results:There were significant differences between the 2 groups in age [(66.8±7.0) versus (64.2±9.6) years], body mass index (BMI) [(28.7±2.2) versus (25.0±2.4) kg/m 2], smoking (20/57 versus 41/433), diabetes (56/21 versus 172/302), primary hypertension (45/32 versus 174/300), coronary heart disease (50/27 versus204/270), hyperlipidemia (33/44 versus 149/325), varicosity (50/27 versus 166/308), tourniquet time [(97.9±22.6) versus (83.1±10.6) min], intraoperative blood loss [(73.2±40.6) versus (62.4±11.5) mL], postoperative PT [(10.7±0.8) versus (11.9±1.0) s], TT [(15.2±1.3) versus (17.2±2.4) s], FIB [(3.7±0.8) versus (3.2±0.5) g/L], D-dimer [(1.1±1.0) versus (0.8±0.3) μg/L], PLT [(233.4±68.5) versus (178.5±27.8) 10 9/L], postoperative bed time [(17.3±2.6) versus (14.6±3.8) h], KSS [(3.32±0.7) versus (3.61±0.56) points], ESR fall time [(2.90±0.74) versus (1.55±0.64) d] and CRP fall time [(2.90±0.74) versus (1.55±0.64) d] (all P<0.05). Multivariate logistic regression analysis showed that old age (95% CI: 0.890 to 1.112, P=0.034), high BMI (95% CI: 1.012 to 1.214, P=0.046), diabetes (95% CI: 1.002 to 2.590, P=0.020), D-dimer (95% CI: 1.239 to 10.292, P=0.001) and postoperative PLT (95% CI: 1.012 to 1.112, P=0.014) were independent risk factors for MCVT. Reduced postoperative bed time (95% CI: 1.009 to 1.469, P=0.040) was a protective factor. Conclusions:As old age, high BMI, diabetes, and high postoperative levels of D-dimer and PLT may be independent risk factors for MCVT, patients with such characteristics should be alert to MCVT. Early ambulation should be encouraged in patients after unilateral TKA to reduce postoperative bed time for prevention of the disease.
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Objective:To assess if metagenomic next-generation sequencing (mNGS) of periprosthetic joint tissue can provide an alternative rapid and sensitive tool for the diagnosis of prosthetic joint infection (PJI), especially compared to microbiological culture.Methods:A total of 33 eligible patients who underwent revision arthroplasty from June 2019 to June 2020 in orthopedic surgery department of the first affiliated hospital of Zhengzhou University were retrospectively analyzed. Twenty-one patients were included in PJI group according to the American Academy of Musculoskeletal Infection diagnostic criteria, with 17 cases of knee and 4 cases of hip, including 9 cases of male and 12 cases of female, with an average age of 59.14±14.55 years old (range from 28 to 84), and an average BMI of 23.7±2.8 kg/m 2 (range from 17.7 to 29.4 kg/m 2). Twelve patients were included in aseptic loosening group (control group), with 4 cases of knee and 8 cases of hip, including 4 cases of male and 8 cases of female, with an average age of 53.08±10.05 years old (range from 39 to 70), and an average BMI of 25.2±2.9 kg/m 2 (range from 18.3 to 31.2 kg/m 2 ). Microbiological culture results of synovial fluid and periprosthetic joint tissue and mNGS results of periprosthetic joint tissue were collected. The sensitivity and specificity of mNGS and microbiological culture were calculated and compared. The species of pathogenic microorganismsdetected by the two techniques were summarized. In addition, the impact of antibiotic use on the efficacy of both techniques were compared. Results:mNGS detected 13 positive cases and microbiological culture detected 6 positive cases in the PJI group. In the aseptic loosening group, 1 case was determined positive by mNGS, and all the microbiological culture results were negative. In the diagnosis of PJI, mNGS showed significantly higher sensitivity than that of culture (61.9% vs 28.6%, χ2=4.71, P=0.03), while no statistical difference was observed in terms of specificity (91.7% vs 100%, χ2=1.04, P=0.31). In the PJI cases with prior exposure to antibiotics within two weeks, the sensitivity of mNGS was significantly higher than that of culture (53.8% vs 15.4%, χ2=4.25, P=0.04). However, there was no significant difference in the sensitivity between mNGS and culture in patients without antibioticsexposure (66.7% vs 44.4%, χ2=0.90, P=0.34). In the detection of pathogenic microorganism, mNGS detected 9 kinds of bacteria (Staphylococcus aureus, Staphylococcus family, Moraxella Oslo, Propionibacterium acnes, Streptococcus acnes, Staphylococcus epidermidis, Mycobacterium tuberculosis, Staphylococcus Lyons, Bacteroides fragilis) and 2 kinds of fungi (Aspergillus fumigatus, Candida parapsilosis), while microbiological culture detected 3 kinds of bacteria (Staphylococcus aureus, Moraxella catarrhalis, Mycobacterium tuberculosis) and one kind of fungi (Candida parapsilosis). mNGS and microbiological culture were both positive in 5 cases, among which 3 cases had completely matched results (Staphylococcus aureus, Mycobacterium tuberculosis, Candida parapsilosis), one case had partly matched results (mNGS detected more bacteria than culture) and one case had totally mismatched results. Additionally, in the diagnosis of the 3 included tuberculous PJI, mNGS showed 100% specificity and sensitivity. Conclusion:mNGS of periprosthetic joint tissue is a more powerful tool for diagnosis and pathogen detection of PJI compared to microbiological culture, especially in the diagnosis of tuberculosis PJI. Besides, mNGS is more resistant to antibiotic exposure than culture.
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Objective:To investigate the feasibility of replacing the femoral prosthesis and implanting antibiotic calcium sulfate carriers in a two-stage revision for periprosthetic infection following total knee arthroplasty (TKA).Methods:Between May 2017 and January 2020, 35 patients were admitted to Department of Orthopaedic Surgery, The First Affiliated Hospital to Zhengzhou University for periprosthetic infection after TKA. They were 12 males and 23 females, aged from 49 to 84 years (average, 67.9 years). The two-stage revision for periprosthetic infection was performed for all of them and replacement of femoral prosthesis and implantation of antibiotic calcium sulfate carriers were carried out in stage-one revision. Recorded were postoperative culture of micro-organisms, white blood cell count (WBC), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) before stage-one and stage-two revisions; the Hospital for Special Surgery (HSS) knee score, range of motion (ROM) and American Knee Society Score (KSS) were compared between preoperation and the last follow-up.Results:Postoperative negative culture was found in 22 cases (62.9%), and positive one in 13 cases (37.1%) of which 4 were caused by Staphylococcus aureus, 2 by Staphylococcus epidermidis, 2 by Candida glabrata, 2 by Candida parapsilosis, one by Candida albicans, one by Mycobacterium tuberculosis and one by Escherichia coli. WBC, ESR and CRP decreased on average from 13.67×10 9/L, 49.71 mm/h and 45.13 mg/L before stage-one revision to 6.44×10 9/L, 18.79 mm/h and 7.82 mg/L before stage-two revision. All patients were followed up for an average of 22.4 months (from 8 to 41 months). At the last follow-up, ROM, HSS and KSS were significantly increased from preoperative 73.2°±15.9°, 59.5±14.6 and 36.1±6.0 to 105.6°±13.2°, 84.3±10.0 and 86.1±5.6, respectively ( P<0.05). None of the patients showed any sign of re-infection at the last follow-up. Conclusion:For patients with periprosthetic infection following total knee arthroplasty, replacing femoral prosthesis and implantation of antibiotic calcium sulfate carriers can well control infection, facilitating recovery of range of motion and function after surgery.
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2,5-dimethylpyrazine (2,5-DMP) is of important economic value in food industry and pharmaceutical industry, and is now commonly produced by chemical synthesis. In this study, a recombinant Escherichia coli high-efficiently converting L-threonine to 2,5-DMP was constructed by combination of metabolic engineering and cofactor engineering. To do this, the effect of different threonine dehydrogenase (TDH) on 2,5-DMP production was investigated, and the results indicate that overexpression of EcTDH in E. coli BL21(DE3) was beneficial to construct a 2,5-DMP producer with highest 2,5-DMP production. The recombinant strain E. coli pRSFDuet-tdh(Ec) produced (438.3±23.7) mg/L of 2,5-DMP. Furthermore, the expression mode of NADH oxidase (NoxE) from Lactococcus cremoris was optimized, and fusion expression of EcTDH and LcNoxE led to balance the intracellular NADH/NAD⁺ level and to maintain the high survival rate of cells, thus further increasing 2,5-DMP production. Finally, the accumulation of by-products was significantly decreased because of disruption of shunt metabolic pathway, thereby increasing 2,5-DMP production and the conversion ratio of L-threonine. Combination of these genetic modifications resulted in an engineered E. coli Δkbl ΔtynA ΔtdcB ΔilvA pRSFDuet-tdhEcnoxELc-PsstT (EcΔkΔAΔBΔA/TDH(Ec)NoxE(Lc)-PSstT) capable of producing (1 095.7±81.3) mg/L 2,5-DMP with conversion ratio of L-threonine of 76% and a yield of 2,5-DMP of 28.8% in 50 mL transformation system with 5 g/L L-threonine at 37 °C and 200 r/min for 24 h. Therefore, this study provides a recombinant E. coli with high-efficiently catalyzing L-threonine to biosynthesize 2,5-DMP, which can be potentially used in biosynthesis of 2,5-DMP in industry.
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Escherichia coli/genetics , Lactococcus , Metabolic Engineering , Pyrazines , ThreonineABSTRACT
Objective:To investigate the treatment effect of marrow mesenchymal stem cells (MSC)/endothelial progenitor cells (EPC) extracellular matrix-based tissue engineering bone (ECM-TEB) in repair of femoral defects in rats.Methods:Bone marrow-derived MSC and EPC were isolated and cultured for functional identification, and planted on the nanocrystalline collagen-based artificial bone particles. After culturing for 14 days, the cells were lyophilized to obtain MSC/EPC ECM-TEB and MSC ECM-TEB. A scanning electron microscope was used to observe the morphology of MSC and EPC on the surface of the scaffold. The protein extracts of MSC ECM-TEBs (control group) and the protein extracts of MSC/EPC ECM-TEBs (experimental group) were added to the EPC culture system for migration test, scratch repair assay, and tube formation detection; and to the MSC culture system for alizarin red staining and alkaline phosphatase? (ALP) staining detection. The cell recruitment, angiogenesis and osteogenic differentiation were observed. A total of 12 SD rats were selected to establish a femoral defect model. According to the random number table, the rats were divided into: (1) sham group: debridement treatment was performed only at the defect; (2) MSC ECM -TEB group: MSC ECM-TEB was implanted at the defect; (3) MSC/EPC ECM-TEB group: MSC/EPC ECM-TEB was implanted at the defect, with 4 rats per group. Two months later, micro-computed tomography (Micro-CT) and Masson's tricolor staining were performed to observe the treatment effect of the bone defect. When the cells were stored at low temperature for three months after lyophilization, the different protein profile between MSC ECM-TEB and MSC/EPC ECM-TEB in vascularization was detected by isotope relative labeling and absolute quantification technology (iTRAQ). The gene ontology/Kyoto Encyclopedia of Gene and Genome Technology (GO/ KEGG) function enrichment was used to analyze the key differences.Results:MSC and EPC grew well and formed a smooth cell layered structure on the surface of the scaffold. The number of cell migration, ratio of scratch repair, and length of the tube in experimental group were respective 121.6±8.3, (61.5±5.9)%, (11.3±0.6)mm, significantly increased compared with control group [85.0±6.7, (39.3±3.6)%, (5.9±0.4)mm] (all P<0.01). Alizarin red staining and ALP staining results showed that the proportion of calcium nodule mineralized area in experimental group increased significantly compared with control group [(38.8±3.3)%∶(49.9±3.0)%, (38.8±2.4)%∶(45.3±3.3)%] (all P<0.05). Base on the Micro-CT and Masson staining, bone defect healing was good in MSC/EPC ECM-TEB group, only a small amount of new bone was formed in MSC ECM-TEB group, and there was almost no new bone regenerated in sham group. Significant differences were found in bone volume/total volume, trabecular number and trabecular thickness among groups (all P<0.05), which were in line with Micro-CT and Masson staining results. The protein profile analysis showed that 83 angiogenesis-related factors in MSC/EPC ECM-TEB group were significantly up-regulated compared with MSC ECM-TEB group (fold change>2, P<0.05). GO/KEGG function enrichment analysis showed that MSC/EPC ECM-TEB group had projecting ascendancy in "vascular development" and in "vascular smooth muscle contraction pathway" compared with MSC ECM-TEB group (both P<0.01). Conclusion:MSC/EPC ECM-TEB has advantages in cell recruitment, angiogenesis, and new bone formation compared with MSC ECM-TEB, and is a better construction strategy for repair of traumatic bone defect.
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Objective:To investigate the clinical effect of titanium cable binding plate combined with lengthened proximal femoral nail antirotation (PFNA) for fixation of recurrent fracture after treatment of unstable intertrochanteric fractures.Methods:A retrospective case series study was conducted for analyzing the clinical data of 17 patients with recurrent fracture of unstable intertrochanteric fractures admitted to Southwest Hospital of Army Medical University from January 2010 to January 2018. There were 7 males and 10 females, aged from 65 to 94 years [(75.7±13.2)years]. The patients were treated using titanium cable binding plate combined with PFNA. Anti-osteoporosis therapy was applied as well. X-ray images were performed at postoperative 3 days, 3, 6 and 12 months. The healing and complications of the patients were recorded. The Harris hip score, visual analogue score (VAS), physical health score (PCS), mental health score (MCS) and 36-item short form health survey questionnaire (SF-36) were evaluated before operation and at postoperative 6 and 12 months.Results:All patients were followed up for 12-18 months [(15.3±2.8)months]. Bone healing was achieved in all patients, and the postoperative bone healing time was 3-6 months [(3.6±1.1)months]. One patient developed lumbosacral pressure sores and recovered after dressing change. Two patients developed drooping pneumonia, which was completely relieved after symptomatic treatment including nebulized inhalation of antibiotics and sputum aspiration. At postoperative 6 and 12 months, Harris hip score was (76.5±5.2)points and (85.5±5.7)points, significantly higher than (32.8±5.1)points before operation ( P<0.05); VAS was (3.3±0.5)points and (1.2±0.7)points, significantly lower than (8.5±0.7)points before operation ( P<0.05); PCS was (44.2±4.9)points and (56.9±5.8)points, significantly higher than (29.3±4.7)points before operation ( P<0.05); MCS was (47.9±6.8)points and (58.4±7.9)points, significantly higher than (39.7±5.9) points before operation ( P<0.05); SF-36 was (493.9±85.7)points and (603.4±76.8)points, significantly higher than (415.9±88.2)points before operation ( P<0.05). Conclusions:Titanium cable binding plate combined with lengthening PFNA can provide stability of fracture end, promote fracture healing, reduce complications, relieve pain and improve patients' quality of life for recurrence of unstable intertrochanteric fracture.
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According to the pathological characteristics of symptomatic chronic thoracic and lumbar osteoporotic vertebral fracture (SCOVF), the different clinical treatment methods are selected, including vertebral augmentation, anterior-posterior fixation and fusion, posterior decompression fixation and fusion, and posterior correction osteotomy. However, there is still a lack of a unified understanding on how to choose appropriate treatment method for SCOVF. In order to reflect the new treatment concept and the evidence-based medicine progress of SCOVF in a timely manner and standardize its treatment, the clinical guideline for surgical treatment of SCOVF is formulated in compliance with the principle of scientificity, practicability and advancement and based on the level of evidence-based medicine.
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Objective:To explore the feasibility and superiority of applying digital orthopedic technology of virtual human reconstruction and 3D printing to CBL teaching of kyphosis for clinical postgraduates.Methods:Thirty postgraduates of professional degree participated in the standardized training of resident doctors in our department were randomized into the experimental group (New CBL teaching mode group) and the control group (traditional teaching mode group) with 15 students in each group, and the two groups were taught differently (the teaching content was two typical cases of kyphosis). Among them, the experimental group adopted the new CBL teaching mode, and successively conducted small class theory teaching, model explanation, group discussion, preoperative design, surgery observation and specific questions and answers, etc. The control group only used the traditional method to teach theory in a large class. The teaching effect of the two groups was evaluated in t test by SPSS 25.0.Results:For the teaching of patients with ankylosing spondylitis and kyphosis, scores of the satisfaction with class interest, mastery of theoretical knowledge and understanding of operation plan in the experimental group were (9.4±0.2), (91.1±3.8), and (91.5±3.5) respectively, and those in the control group were (8.2±0.4), (82.1±3.5) and (83.1±4.7) respectively, with statistical significance ( P<0.05). Conclusion:In the teaching of kyphosis, the CBL teaching mode based on digital orthopedic technology is superior to the traditional teaching mode, which is conducive to improving clinical skills for students.
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Objective:To compare the effects between video-assisted thoracoscopic surgery (VATS) and conventional surgery in internal fixation of multiple rib fractures.Methods:Patients with multiple rib fractures, who were admitted to Emergency Center of Shenzhen People's Hospital from June 2010 to May 2020, were included. Patients were divided into the VATS group (incision positioning with VATS) and the conventional group (incisionpositioning with CT scan). The primary outcome measures was the risk of complications, and the secondary outcome measures included postoperative pain, incision length, operation time, and mechanical ventilation rate. Continuous and categorical variables were compared using LSD- t test and Chi-square test. Repeated measures analysis of variance was performed to assess the trend of postoperative pain over time. A logistic regression analysis was used to explore the association of VATS with postoperative complications. Results:A total of 221 patients, including 128 patients in the VATS group and 93 patitents in the conventional group, were enrolled. Baseline characteristics were identical between the two groups ( P>0.05). In the VATS group, the length of incision, intraoperative blood loss, operation time, mechanical ventilation rate after operation, ventilation time, thoracic tube indwelling time, ICU and total length of stay, and medical costs were better than those in the conventional group (all P<0.05). Repeated measures analysis of variance showed that pain relief was faster and more profoundly in the VATS group than in the conventional group ( F=3 517.808, P<0.01). Logistic regression analysis indicated that VATS was an independent protective factor for reducing postoperative complications ( OR=0.225, 95% CI:0.121-0.416, P<0.01). Conclusions:During internal fixation of multiple rib fractures, VATS is an effective approach to reduce postoperative pain and complications. Moreover, video-assisted technique is associated with a rapid recovery for patients, resulting in shorter length of hospital stay and less medical costs.
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Objective To explore the diagnostic value of serum carcinoembryonic antigen (CEA), carbohydrate antigen 724 (CA724) combined with long non-coding RNA MALAT1 in gastric cancer. Methods A total of 100 patients with gastric cancer diagnosed in Changzhou Cancer Hospital, Soochow University from March 2013 to February 2018 were collected as the case group, and 100 healthy people during the same period in our hospital were collected as the control group. The levels of serum CEA, CA724 were detected by using chemiluminesent immunoassay assay, and the relative expression of MALAT1 was detected by using real-time fluorescence quantification polymerase chain reaction (PCR). The relationships between CEA, CA724, MALAT1 and the clinicopathological features of gastric cancer were analyzed. Receiver operating characteristic (ROC) curve was used to analyze the diagnostic value of CEA, CA724 and MALAT1 in patients with gastric cancer. The odds ratio (OR) and 95％ confidence interval (CI) were calculated by using logistic regression. Results The levels of serum CEA, CA724 and MALAT1 in the case group were higher than those in the control group [(3.08 ±0.21) ng/ml vs. (0.74 ±0.11) ng/ml, t= 3.814, P= 0.002; (4.28 ±0.17) U/ml vs. (0.51± 0.07) U/ml, t=4.703, P<0.01; (113.9±3.9) vs. (36.1±1.2), t=7.160, P<0.01 respectively], and the three indexes were related to the pathological types and TNM staging of gastric cancer (all P< 0.05), and the most significant increase was seen in tubular adenocarcinoma patients and stage Ⅲ-Ⅳ patients. ROC curve analysis showed that the area under curve (AUC) of serum CEA, CA724 and MALAT1 in the differential diagnosis between the gastric cancer and the healthy people were 0.675 (95％CI 0.578-0.755, P= 0.001), 0.865 (95％CI 0.800-0.922, P< 0.01) and 0.847 (95％CI 0.771-0.911, P< 0.01), and the sensitivity was 69.1％, 80.2％, 85.8％, and specificity was 63.5％, 77.4％, 74.5％, respectively. AUC of combination of the three indicators for diagnosis of gastric cancer was 0.887 (95％CI 0.821-0.949, P<0.001), and the sensitivity was 84.3％ and the specificity was 91.9％. Logistic regression results showed that high levels of serum CEA, CA724 and MALAT1 were risk factors for gastric cancer. After adjusting for age, sex, smoking history and drinking history, high levels of serum CEA, CA724 and MALAT1 remained the independent risk factors for gastric cancer. Conclusion The combined detection of serum CEA, CA724 and MALAT1 can be used to predict the risk of gastric cancer, and the three have a value for the diagnosis of gastric cancer, which is worthy of clinical application.
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Objective@#To investigate the effects of preoperative percutaneous transhepatic biliary drainage on surgical treatment of type Ⅲ and Ⅳ hilar cholangiocarcinoma.@*Methods@#Clinical data of 72 patients with hilar cholangiocarcinoma of the Bismuth-Corlette type Ⅲ and Ⅳ treated at Department of General Surgery,First Affiliated Hospital of Bengbu Medical College from January 2010 to December 2017 were analyzed retrospectively.Patients were divided into two groups based on whether PTBD was performed:a drained group and an undrained group.In the drained group,there were 31 patients,20 males and 11 females,aged (59.9±9.7)years (range: 39-73 years).Among them,14 patients underwent hepatectomy with half or more than half of the liver removed (extended hepatectomy)and 17 patients underwent non-anatomical hepatectomy in the hilar region (limited hepatectomy).In the undrained group,there were 41 patients, 26 males and 15 females, aged (60.8±7.8)years(range: 45-75 years).Among them, 17 patients underwent hepatectomy with half or more than half of the liver removed (extended hepatectomy)and 24 patients underwent non-anatomical hepatectomy in the hilar region (limited hepatectomy).Percutaneous transhepatic biliary drainage(PTBD)was used in the drained group.Under the guidance of ultrasound,one or more hepatobiliary ducts could be sufficiently drained,which had good effect and was not restricted by the obstruction location of hilar cholangiocarcinoma.The analysis of the measurement data was performed using t test,and the analysis of the count data was performed using χ2 test,and the survival curve was plotted using Kaplan-meier method.@*Results@#In total, 72 jaundiced patients with hilar cholangiocarcinoma underwent surgical treatment: 31 had PTBD prior to operation while 41 did not had PTBD.There were significant differences in ALT((93.2±21.4)U/L vs.(207.4±65.1)U/L),AST((87.6±18.1)U/L vs.(188.9±56.6)U/L)and total bilirubin((68.8±12.6)μmol/L vs.(227.5±87.7)μmol/L)between the patients after treatment and those before treatment(t=10.958, P=0.000; t=10.845, P=0.000; t=10.386, P=0.000).Compared with those in the undrained group, the operation time was shorter, the amount of intraoperative bleeding and the incidence of complications were lower in the drained group(t=-2.840, P=0.006; t=-3.698, P=0.000; χ2=4.108, P=0.043).There were no perioperative death cases in drained group and 2 perioperative death cases in undrained group.There was no significant difference in R0 resection rate between the two groups(χ2=0.778,P=0.378).The 1-,3-,5-year survival rate of patients in the drained group and the undrained group was 72.7%,34.2%, 13.7% and 72.8%, 31.5%, 11.8%, respectively.The difference was not statistically significant(all P>0.05).@*Conclusions@#The preoperative percutaneous transhepatic biliary drainage in patients with hilar cholangiocarcinoma of Bismuth-Corlette type Ⅲ and Ⅳ could effectively shorten operative time, reduce amount of intraoperative bleeding and incidence of postoperative complications,but have no significant effect on the R0 resection rate and survival rate.
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Objective To investigate the clinical efficacy of posterior lumbar interbody fusion and internal fixation for the treatment of lumbar spinal stenosis with redundant nerve roots (RNRs).Methods A retrospective case series study was performed on the clinical data of 23 cases of lumbar spinal stenosis with RNRs from January 2009 to December 2014.This study involved 10 males and 13 females,with an average age of 48.4 years(range,38-58 years).The course of disease averaged 28.1 months(range,2 months-7 years).There were seven patients with single segment of stenosis,12 patients with two segments of stenosis,and four patients with three segments of stenosis.RNRs diagnostic criteria:in the sagittal section of the MRIT2 image of lumbar spine,the cauda equina nerve root in the dural sac was circular,tortuous and twining.MRI information was collected and analyzed by three double-blind radiologists,respectively.RNRs were determined based on the unanimous consent of all the three doctors.All patients underwent posterior discectomy,spinal canal decompression,interbody fusion,and internal fixation after admission.The operation time,intraoperative blood loss,and postoperative complications were recorded.The visual analogue scale (VAS),Oswestry disability index (ODI),and Japanese Orthopedic Association (JOA) score were used to evaluate the back pain and leg pain before operation and 3 months after operation.Fischgrund standard was used for the overall efficacy evaluation.Results All patients were followed up for 12-30 months (mean,23.3 months).The operation time was (130.0 ± 23.2) minutes,and the intraoperative blood loss was (513.0 ± 165.0) ml.MRI was reviewed 1 week after operation,and the result showed that redundancy of cauda equina disappeared.Preoperatively,the scores of back pain VAS,leg pain VAS,ODI and JOA were (6.3± 0.8) points,(6.8 ±0.9)points,(46.7±2.5)points and (10.3 ±2.8)points,respectively.At 3 months postoperatively,the scores were (1.4 ± 0.5) points,(1.8 ± 0.7) points,(11.9 ± 2.1) points,and (25.3 ± 1.8) points,respectively (P ＜ 0.05).In terms of the efficacy,17 cases were excellent,four good,and two fair,with an excellent and good rate of 91％.At 12 months after operation,the CT scan showed no screw rupture or cage dislocation,with bony union seen between the vertebrae.Conclusion Posterior lumbar interbody fusion and internal fixation can help relieve the back and leg pain and eliminate redundant nerve roots in patients with lumbar spinal stenosis with RNRs.
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Objective To investigate the mechanism of implanted tissue-engineered bone (TEB)recruiting endogenous mesenchymal stem cells (BMSCs) towards bone regeneration after traumatic bone defect.Methods In vivo experiments:2 mm of diaphysis and periosteum were removed from the middle of the femoral shaft in 8 week old FVB/N mice to form a large segment of bone defect.Demineralized bone matrix (DBM) and TEB were implanted into the defect area and fixated.All mice were randomly divided into DBM group (n =18) and TEB group (n =18).The results were observed 24 hours after implantation:(1) flow cytometry was used to evaluate the number of mobilized host BMSCs into the blood;(2) non-invasive bioluminescent imaging was used to observe the ability of two groups in recruiting mouse bone marrow derived mesenchymal stem cells (mBMSCs) in peripheral blood to the defect area;(3) ELISA was used to evaluate the stromal cell-derived factor 1 (SDF-1) content in peripheral blood of two groups.In vitro experiments:(1) transwell assay was conducted to evaluate the ability of SDF-1 (100 ng/ml) in promoting the migration of human bone marrow derived mesenchymal stem cells (hBMSCs).SDF-1/C-X-C motif chemokine receptor-4 (CXCR4) pathway was blocked by the selective CXCR4 antagonist Plerixafor (AMD3100).The experimental groups were divided into control group,SDF-1 group,and SDF-1 + AMD3100 group.(2) The co-culture system of human umbilical vein endothelial cells (hUVECs) and hBMSCs was established,and cells were stimulated by SDF-1.The experimental groups were divided into hBMSCs group,hBMSCs + hUVECs group,and hBMSCs + hUVECs (AMD3100 pretreatment) group.Transwell assays were used to compare the migration of hBMSCs in each group.ELISA was used to detect the concentration of hepatocyte growth factor (HGF) in the co-culture supernatant.(3) In vitro cultured hUVECs were stimulated by SDF-1 and SDF-1/CXCR4 pathway was antagonized by AMD3100.The experimental groups were divided into control group,SDF-1 group,and SDF-1 + AMD3100 group.Quantitative real-time polymerase chain reaction (qRT PCR) was used to evaluate the expression of HGF in each group.Results In vivo experiments:24 h after transplantation,the number of BMSCs and SDF-1 concentration in the TEB group were significantly highcr than those in the DBM group (P ＜ 0.05).The number of recruited mBMSCs into the circulation in the TEB group was larger than that in the DBM group (P＜ 0.01).In vitro experiments:(1) compared with the control group and the SDF-1 + AMD3100 group,the SDF-1 group significantly enhanced the migration ability of hBMSCs in Transwell migration experiments (P ＜ 0.01);(2) compared with the hBMSCs group and the hBMSCs + hUVECs (AMD3100 pretreatment) group,the number of migrated cells and HGF concentration in the hBMSCs + hUVEC group significantly increased (P ＜ 0.01),but there were no significant differences between the hBMSCs group and the hBMSCs + hUVECs (AMD3100 Pretreatment) group (P ＞0.05);(3) qRT-PCR showed that the expression of HGF was significantly increased in the SDF-1 group compared with the control group (P ＜ 0.05).After antagonizing SDF-1/CXCR4,HGF expression in the SDF-1 + AMD3100 group was significantly lower than that in the SDF-1 group.Conclusions TEB transplantation in traumatic bone defect can significantly increase the concentration of chemokine SDF-1 in vivo and effectively promote the mobilization of endogenous MSCs and recruitment of circulating MSCs.SDF-1 not only directly promotes the migration of hBMSCs through SDF-1/CXCR4 pathway,but also up-regulates the expression and secretion of HGF in vascular cells to further amplify the chemotactic effect of SDF-1 on hBMSCs.
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Objectives To design an objective and structured evaluation system for the clinical competence of orthopedic postgraduates in the diagnosis and treatment of distal radius fractures, and to ana-lyze its reliability and validity. Methods 28 orthopaedic postgraduates representing six levels of surgical training were tested for competence in performing surgical approach for distal radius fracture on cadaver specimens during which four measures were used to assess competency: examination of basic theory based on network item bank, objective structured operation assessment,overall assessment and operation examina-tion results. In addition, the time for completion of the surgery was also recorded. Each assessment tool was correlated with the others as well as with the resident’s level of training. Results There was a significant correlation between the seniority of candidates and the score of theoretical examination (F=6.193, P=0.000), the score of structured operation examination (F=6.374, P=0.002), the score of overall assessment (F=2.321, P=0.030), and the passing rate of final operation examination (F=36.300, P=0.000). No significant differ- ences were found between seniority and time to completion of the surgical approach exposure (F=2.282, P<0.073). Conclusions The results of the present study suggested that both theoretical examination and cadaver testing discriminate between novice and accomplished postgraduates. However, although the theo-retical test scores could predict the operational test results, but the theoretical results can not guarantee excellent operational skills.
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With the increasing of incidence rate of pediatric drug-resistant tuberculosis in recent years,pe-diatric tuberculosis as a threat to global childhood public health was serious disease and attracted more and more pediatrician concern. Pediatric tuberculosis often can′t result to typical clinical symptoms and imaging findings because its quantity of tubercle bacillus was little in lesions of infection,meanwhile,golden standard mycobacterium tuberculosis detection was time-consuming and low positive rate,pediatric tuberculosis can′t get timely diagnosis and therapy,mo-lecular diagnostic techniques of pediatric drug-resistant tuberculosis got widely clinical application and development for its advantage of rapid,accurate,efficiency and easy operation etc,several common molecular diagnostic techniques in pediatric drug-resistant tuberculosis were summarized,which would provide useful guidance for molecular diagnose of pediatric drug-resistant tuberculosis.
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Objective To study whether SGK1 is involved in the phenotypic transformation in adventitial fibroblasts (AF).Methods Vascular AF were separated from the thoracic aortas of SD rats.The AF not stimulated with TGF-β1 were divided into blank group,control group 1 and control group 2.The AF induced with 2.5,5.0,10.0 and 15.0 ng/ml TGF-β1 were divided into groups A-D.The AF pretreated with 50 μmol/1 EMD638683 and SB203580 were divided into inhibitor group 1 and inhibitor group 2.The AF stimulated with 5 ng/ml TGF-β1 were divided into stimulation group 1 and stimulation group 2.The expression of SGK1,α-SMA and collagen Ⅰ was detected by Western blot.Results The expression of SGK1 was significantly higher in groups AC than in blank group.The expression of α-SMA was significantly higher in groups B-D than in controlgroup (P＜0.05).The α-SMA and collage Ⅰ expression levels were significantly higher in stimulation group 1 than in control group 1,and were significantly lower in inhibitor group 1 than in stimulation group 1 (P＜0.05).The SGK1 expression level was significantly higher in stimulation group 2 than in control group 2 and was significantly lower in inhibitor group 2 than in stimulation group 2 (P＜0.05).Conclusion SGK1 participates in TGF-β1-induced phenotypic transformation via p38 MAPK and is thus involved in vascular remodeling.
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Objective To evaluate the sensitivity and specificity of Tag Array in detecting the clinical isolates of bone and joint tuberculosis.Methods Twenty-four strains of Mycobacterium tuberculosis having sequence differences in extracted plasmids of mutant strains.The plasmid was diluted into different concentrations,and then multiplex PCR amplification was performed to analyze the sensitivity and specificity of the chip system.A total of 187 clinical isolates were collected from patients with bone and joint tuberculosis.Among them,there were 50 strains of sensitive bacteria,and 137 strains of drug-resistant.Designed,optimized and prepared chip inspection system,sequencing and phenotypic drug susceptibility results were analyzed to evaluate the sensitivity and specificity of the gene chip.Results The mutants in accordance with sequencing result in the sets with 1 × 103copy/μl of template concentration and above;while 29 sets showed false negative result in the sets with 1 × 102 copy/μl.Among the 126 rifampicin phenotype drug resistance strains,119 strains appeared mutation in rpoB gene.In the rifampicin phenotype sensitivity strains,9 strains of rpoB gene showed mutation,the sensitivity was 94.40％,and specificity was 86.76％.Among the 118 isoniazid phenotype drug resistance strains,109 strains appeared mutation in relevant drug resistance gene locus,the sensitivity was 92.37％,and specificity was 81.16％.Among the 44 ethambutol phenotype drug resistance strains,27 strains appeared mutation in locus embB306,in the ethambutol phenotype sensitivity strains,the mutation in locus embB306 was detected in 6 strains,the sensitivity was 61.36％,and specificity was 95.80％.Among the 102 levofloxacin phenotype drug resistance strains,81 strains appeared mutation in gyrA gene,4 of the sensitivity strains were detected mutation in gyrA gene,the sensitivity was 79.41％,and specificity was 95.29％.Among the 112 streptomycin phenotype drug resistance strains,the chip detected 101 strains appeared mutation,the sensitivity of chip detection was 90.17％,and specificity was 84.00％.Since amikacin,capreomycin and kanamycin are in cross drug resistance,among the 67 phenotype drug resistance strains,52 strains appeared mutation in relevant drug resistance gene locus,its sensitivity was 79.10％ and specificity was 90.83％.Conclusion Tag Array chip can achieve rapid,accurate and high-throughput detection of tuberculosis resistance,which has important clinical significance and feasibility.
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Objective To compare the clinical effects of posterior pedicle screw fixation combined with anterior monosegmental or bisegmental fusion reconstruction in patients with unstable Denis type B thoracolumbar burst fractures.Methods A retrospective case-control analysis was made on 62 cases of Denis type B thoracolumbar burst fractures treated from June 2010 to June 2014.There were 51 males and 11 females,aged 19-55 years (mean,35.1 years).The injury causes included fall from height in 32 cases,traffic accidents in 24,hit by heavy objects in 6.Fifty cases were with monosegmental burst fractures,and 12 with monosegmental burst fractures combined with other vertebral compressive fractures.The burst fracture levels were at T~in 8 cases,T12in 20,L1 in 24,L2 in 6,and L3 in 4.According to the different surgical methods,the patients were divided into two groups:Group A (n =30,treated with posterior pedicle screw fixation combined with anterior monosegmental fusion reconstruction) and Group B (n =30,treated with posterior pedicle screw fixation combined with anterior bisegmental fusion construction).The operation time and intraoperative blood loss were compared between the two groups.Visual analogue scale (VAS),Oswestry disability index (ODI),and Frankel scale of neurologic function were compared at last follow-up.The changes of anterior height of fracture vertebrae and Cobb angle of the two groups were also compared preoperatively,postoperatively and at last follow-up.Implant looseness and breakage,titanium mesh tilt,and bone fusion were recorded postoperatively.Results All patients were followed up for 18-24 months (mean,20.8 months).The operation time and blood loss in Group A was (208.2 ± 15.6) min and (598.3 ± 55.3) ml,respectively.The operative time and blood loss in Group B was (260.1 ± 17.4)min and (662.2± 58.3)ml,respectively.There were significantly statistical differences between two groups in operation time and blood loss (P ＜0.05).There were no statistical differences between two groups in terms of Cobb angle restoration and fracture height restoration rate after surgery,Cobb angle loss and fracture vertebral body front height loss rate at final follow-up (P ＞ 0.05).At the final follow-up,VAS in Group A was (2.5 ± 0.8) points,less than (3.2 ± 1.1) points in Group B (P ＜ 0.05);ODI in Group A was (20.3 ± 5.8) points,less than (28.2 ± 5.1) points in Group B (P ＜ 0.05).Frankel scale was improved to some degree after operation (P ＜ 0.05).One case did not achieve bone fusion in Group A versus three cases in Group B (P＜0.05).No implant Loosening,titanium mesh tilt or settlement was found in Group A,while there were eight cases of titanium mesh tilt or settlement in Group B (P ＜0.05).Conclusions For unstable Denis type B thoracolumbar burst fractures,posterior pedicular fixation combined with anterior monosegmental fusion or bisegmental fusion can achieve equal clinical effects.However,posterior pedicular fixation combined with anterior monosegmental fusion can have less injury,higher bone fusion rate,better function restoration,and less incidence of complication.