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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 prepare the hydrogel scaffolds with different concentrations of laponite and compare their osteogenic properties.Methods:The scaffolds of gelatin/sodium alginate hydrogel into which laponite was added according to the mass ratios of 0%, 1%, 2%, and 3% were assigned into groups T0, T1, T2, and T3. In each group, the compressive modulus was measured and the leaching solution for 24 h extracted to measure the ion release. Bone marrow mesenchymal stem cells (BMSCs) were cultured in the extract medium from each group and common medium (blank group) ( n=3) in the in vitro experiments to determine the expression of osteogenic genes Runt-related transcription factor 2 (Runx2), alkaline phosphatase (ALP) and type I collagen after 7 days of culture. In the in vivo experiments, the scaffolds were implanted into the femoral condyle defects in rats, and a blank group with no scaffolds was set. The bone repair in each group was evaluated by hematoxylin-eosin(HE) staining and immunohistochemical staining. Results:The compressive modulus in group T2 [(139.05±6.43) kPa] was significantly higher than that in groups T0, T1 and T3 [(68.83±3.76) kPa, (101.18±3.68) kPa and (125.40±3.28) kPa] ( P<0.05). The ion contents of lithium, magnesium and silicon released from the 24 h leaching solution in group T2 were (0.031±0.005) μg/mL, (3.047±0.551) μg/mL and (5.243±0.785) μg/mL, insignificantly different from those in group T3 ( P> 0.05) but significantly larger than those in group T1 ( P>0.05). The in vitro experiments showed that the expression levels of Runx2, ALP and type I collagen in group T2 were 1.59±0.11, 2.02±0.08 and 1.06±0.17, significantly higher than those in the other groups ( P<0.05). HE staining showed that the implanted hydrogel was tightly bound to the bone tissue. Immunohistochemical staining showed that the numbers of Runx2 and osteocalcin positive cells in group T2 were significantly higher than those in the other groups. Conclusions:With ideal biocompatibility, hydrogel scaffolds with different concentrations of laponite can slowly release the decomposed ions of lithium, magnesium and silicon to promote the osteogenic differentiation of BMSCs and the repair of bone defects in vivo. A 2% concentration of laponite in the hydrogel scaffolds may result in the best results.
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Objective:To characterize the biological activity of fibroblasts on the surface of titanium alloy sheets with different ridge widths by investigating the effects of ridge widths on the adhesion, proliferation and differentiation of fibroblasts.Methods:Five groups of titanium sheets with ridge widths of 50 μm, 80 μm, 100 μm, 150 μm and 200 μm were prepared, with all the groove depths being 10 μm. The titanium sheets with no ridges were taken as a control group. After fibroblasts were incubated on the sheets, states of their adhesion were observed by scanning electron microscopy (SEM) at different time points. CCK-8 cell proliferation test and immunofluorescence staining were used to observe proliferation and shape of the cells. The effects of ridge widths on adhesion of fibroblasts were evaluated by Vinculin immunofluorescence staining, and the effects of ridge widths on expression of α-smooth muscle actin ( α-SMA) by immunofluorescence. Results:SEM showed that the cells adhered to the ridges on the titanium sheets 48 hours after inoculation. In the groups with smaller ridge widths (from 50 μm to 150 μm), the cells were slender in shape and grew along the ridge direction. CCK-8 indicated that different ridge widths had no significant effect on the proliferation of fibroblasts between the 6 groups ( P>0.05). Immunofluorescence staining showed that the cells arranged in an orderly direction along the ridges; the long axis of the cells in the 50 μm group showed the best consistency with the extending direction of the ridge, with significant differences among the 6 groups ( P<0.05). The Vinculin test found that the secretion of cell adhesion protein was concentrated in the ridge and semi-quantitative analysis showed that the 50 μm group had the most Vinculin secretion, with significant differences among the 6 groups ( P<0.05). The α-SMA test showed that the ridge width had a regulatory effect on the myogenic differentiation of fibroblasts, and the 50 μm group had the strongest expression of α-SMA, with significant differences among the 6 groups ( P<0.05). Conclusions:Modification of ridges on the surface of titanium sheets may affect arrangement, adhesion and myogenic differentiation of fibroblasts. The ridges of 50 μm in width may lead to stronger polarized arrangement of fibroblasts, more secretion of adhesion-related protein and more pronounced myogenic differentiation of fibroblasts.
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PURPOSE@#Low-velocity penetrating brain injury (LVPBI) caused by foreign bodies can pose life-threatening emergencies. Their complexity and lack of validated classification data have prevented standardization of clinical management. We aimed to compare the trans-base and trans-vault phenotypes of LVPBI to help provide guidance for clinical decision-making of such injury type.@*METHODS@#A retrospective study on LVPBI patients managed at our institution from November 2013 to March 2020 was conducted. We included LVPBI patients admitted for the first time for surgery, and excluded those with multiple injuries, gunshot wounds, pregnancy, severe blunt head trauma, etc. Patients were categorized into trans-base and trans-vault LVPBI groups based on the penetration pathway. Discharged patients were followed up by outpatient visit or telephone. The data were entered into the Electronic Medical Record system by clinicians, and subsequently derived by researchers. The demography and injury characteristics, treatment protocols, complications, and outcomes were analyzed and compared between the two groups. A t-test was used for analysis of normally distributed data, and a Mann-Whitney U test for non-parametric data. A generalized linear model was further established to determine whether the factors length of stay and performance scale score were influenced by each factor.@*RESULTS@#A total of 27 LVPBI patients were included in this analysis, comprised of 13 (48.1%) trans-base cases and 14 (51.9%) trans-vault cases. Statistical analyses suggested that trans-base LVPBI was correlated with deeper wounds; while the trans-vault phenotype was correlated with injury by metal foreign bodies. There was no difference in Glasgow Coma Scale score and the risk of intracranial hemorrhage between the two groups. Surgical approaches in the trans-base LVPBI group included subfrontal (n = 5, 38.5%), subtemporal (n = 5, 38.5%), lateral fissure (n = 2, 15.4%), and distal lateral (n = 1, 7.7%). All patients in the trans-vault group underwent a brain convex approach using the foreign body as reference (n = 14, 100%). Moreover, the two groups differed in application prerequisites for intracranial pressure monitoring and vessel-related treatment. Trans-base LVPBI was associated with higher rates of cranial nerve and major vessel injuries; in contrast, trans-vault LVPBI was associated with lower functional outcome scores.@*CONCLUSION@#Our findings suggest that trans-base and trans-vault LVPBIs differ in terms of characteristics, treatment, and outcomes. Further understanding of these differences may help guide clinical decisions and contribute to a better management of LVPBIs.
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Objective:To prepare biomimetic tissue engineering scaffolds of gelatin/sodium alginate/laponite composite hydrogel loaded with BMSCs by 3D biological printing technique，and explore the osteogenic effect of 3D printing on hydrogel scaffolds containing bone marrow mesenchymal stem cells（BMSCs）.Methods:BMSCs were routinely extracted and identified by flow cytometry. Gelatin，sodium alginate and laponite were mixed and then BMSCs were added to prepare cell-containing composite hydrogel scaffolds using 3D bioprinting. Non-printed scaffolds containing cells were prepared by injection molding method. In vitro，the prepared scaffolds were divided into the printing group with cells and non-printing group with cells according to whether they were printed，with 12 samples per group. Another simple cell culture group was set as control. Then，the internal structure of the composite hydrogel was observed by scanning electron microscope，and the expansion rate and water content of the scaffolds were measured by freeze-drying method. At day 3 after culture，the growth status of BMSCs was observed by phalloidine staining. cell counting kit（CCK）-8 assay was used to detect cell activity in scaffolds at days 1，3，and 7 after culture and RT-PCR to detect the expression of osteogenesis related genes Osterix，osteocalcin（OCN）and collagen I at days 7 and 14 ofter culture. In vivo，four groups were set according to printing or not and whether containing cells or not：printing implant group with cells，non-printing implant group with cells，printing implant group without cells and non-printing implant group without cells，with 9 samples per group. Scaffolds in four groups were implanted to the posterior gluteal muscle pouches（random on left or right）of 36 8-week-old SD rats，respectively. The samples were taken X-ray images at 2，4 and 8 weeks after operation，respectively. The osteogenic differentiation of tissues at 8 weeks was observed by HE and Masson staining. Results:The flow cytometry showed that the cells were BMSCs. Internal pores of hydrogels were obvious，and cells stretched freely in the pores. Differences of the swelling rate and water content were not statistically significant between printing group with cells［（1，039.37±30.66）%，（91.21±0.26）%］and non-printing group with cells［（1，032.38±35.05）%，（91.16±0.28）%］（ P>0.05）. At day 3 after culture in vitro，the cells grew well in the hydrogel. After culturing for 1 day in vitro，there was no significant difference in absorbance between printing group with cells and non-printing group with cells（ P>0.05）. At day 3 after culture，there was no significant difference in absorbance between printing group with cells and non-printing group with cells，but both groups showed a higher level than simple cell culture group（ P<0.05）. At day 7 after culture，the absorbance in printing group with cells（2.72±0.17）was higher than that in non-printing group with cells（2.35±0.11），and both of which were higher than that in simple cell culture group（1.95±0.12）（ P<0.05）. At day 7 after culture in vitro，there was no statistically significant difference in the expression of osteogenic differentiation-related genes between printing group with cells and the non-printing group with cells（ P>0.05），but they were all higher than those in simple cell culture group（ P<0.05）. At day 14 after culture in vitro，the expression of osteogenesis-related genes Osterix（1.650±0.095），OCN（2.725±0.091），collagen I（2.024±0.091）in printing group with cells were higher than those in non-printing group with cells（1.369±0.114，2.174±0.198，1.617±0.082，respectively）and those in simple cell culture group（1.031±0.094，1.116±0.092，0.736±0.140，respectively）（ P<0.05）. After implantation for 2 weeks in vivo，with no statistically significant difference in the gray values of X-ray films in each group（ P>0.05）. At weeks 4 and 8 after implantation，the gray values of X-ray films in printing implant group with cells and non-printing implant group with cells were higher than those in printing implant group without cells and non-printing implant group without cells（ P<0.01）. At 8 weeks after implantation，HE staining showed that the scaffolds were degraded in different degrees and immersed with cells，with collagen production seen in Masson staining as well. Conclusions:Composite hydrogel scaffolds can provide a good three-dimensional environment for BMSCs growth. 3D bioprinting can promote the proliferation and osteogenic differentiation of BMSCs in hydrogel scaffolds. In addition，BMSCs-loaded scaffolds can be degraded slowly in vivo with good ectopic osteogenic ability.
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Objective:To analyze the therapeutic effect of medial gastrocnemius muscle flap transfer combined with induced membrane technique in repairing anterior medial Gustilo-Anderson type ⅢB injury of the middle and upper tibia accompanied by bone defect.Methods:A retrospective case series study was conducted to analyze 21 patients with anterior medial Gustilo-Anderson type ⅢB injury of middle and upper tibia accompanied by bone defectanterior medial tibial fractures admitted to Xijing Hospital，Air Force Military Medical University from April 2017 to January 2019. There were 15 males and 6 females，with the age of （38.6 ± 7.6）years （range，18-66 years）. After admission，all patients had bone defect repair and fixation and soft tissue defect repair using membrane induction technique in the first stage. The area of soft tissue defect ranged from 8.0 cm × 6.0 cm to 16.0 cm × 12.0 cm. The length of tibial defect was （5.5 ± 1.8） cm （ranged，3.5-11.0 cm）. The size of metastasis of medial gastrocnemius flap ranged from 12.0 cm × 8.0 cm to 22.0 cm × 13.0 cm. The survival rate of muscle flap was observed. One week after the wound was stabilized，skin grafting on the surface of muscle flap was performed at second stage. The graft survival was observed. The induced membrane technique was used to reconstruct bone defects at third stage. The infection index，lower extremity functional scale （LEFS） and Mazur ankle function score were compared before and at the last follow-up. The fracture healing and related complications were observed，and the lower limb function was evaluated by Johner-Wruhs scoring system at the last follow-up.Results:All patients were followed up for 11-26 months ［（18.4 ± 5.1） months］. The muscle flap transferred survived in all patients at first stage. The skin graft survived at second stage，and the wound healing time was 1-4 weeks ［（3.1 ± 0.5）weeks］. After the surgery at third stage，the healing time of bone fracture was （8.2 ± 0.7）months （range，6-10 months）. A significantly lowered level of infection was observed at the last follow-up compared to that before operation （ P < 0.01）. The LEFS and Mazur ankle function scores of the affected limb were （52.2 ±8.9）points and （75.2 ± 13.1）points at the last follow-up，significantly higher than those before operation ［（36.0 ± 5.6）points，（53.7 ± 14.6）points］ （ P < 0.01）. The soft tissue defect was repaired satisfactorily，and the broken ends of bone defects were healed at the last follow-up. Delayed bone union occurred in 3 patients，but no infection，osteomyelitis，foot drop or other complications occurred. According to Johner- Wruhs score，18 patients were rated as excellent，2 patients as good，1 patient as fair and 0 patient as poor，with the excellent and good rate of 95%. Conclusion:For patients with anterior medial Gustilo-Anderson type ⅢB injury of the middle and upper tibia accompanied by bone defect，transfer of medial gastrocnemius head muscle flap combined with induced membrane technique can effectively repair the injured limb，reduce infection and restore partial function of the lower limb，indicating that the procedure is an effective treatment strategy with satisfactory clinical results.
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Objective To compare the function recovery of multiple injuries combined with floating knee joint injury and simple knee joint injury,and to analyze the risk factors.Methods A retrospective case control study was conducted to analyze the clinical data of 41 patients with multiple injuries combined with Blake and McBryde Ⅱ A floating knee injury admitted to Xijing Hospital of Air Force Medical University from June 2011 to June 2017.There were 26 males and 15 females,aged 18-76 years,with an average of 34.5 years.There were 25 patients with simple knee joint injury and and 16 patients with multi-joint combined injury involving knee joint and ipsilateral hip joint or ankle joint injury.Surgical fixation was performed in different parts by external fixation,intramedullary nail and plate screw fixation.According to the Kalstr(o)m and Olerud functional evaluation criteria,the excellent and good rate of postoperative functional recovery was compared between the two groups.The surgical fixation methods of the two groups were compared.Logistic regression analysis was performed on the influencing factors of functional recovery.Results The patients were followed up for 1-7 years,with an average of 3 years.The excellent and good rate of overall functional recovery in the two groups was 68％,and the rate was 84％ in simple knee injury group and 44％ in multi-joint combined injury group (P ＜ 0.01).There was no significant difference in the ratio of intramedullary nail and plate screw fixation between the two groups (P ＞ 0.05),while the proportion of the external fixation in the multi-joint combined injury group [31％ (5/16)] was significantly higher than that in the simple knee joint injury group [16％ (4/25)] (P ＜ 0.05).Logistic regression analysis showed that the rate of external fixation was an independent factor affecting the postoperative function (OR =0.15,P ＜ 0.01).Conclusions The postoperative function in multi-joint injury patients is poorer than in the single joint injury patients.The higher rate of using external fixation in multi-joint injury patients is a risk factor.For Blake and McBryde Ⅱ A floating knee injury combined with multi-joint injury,less external fixation should be used,so as to improve the postoperative function.
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With the increasing number of patients receiving fracture internal fixation,the number of patients with infection after fracture internal fixation (IAFIF) has gradually increased.IAFIF has severe consequences for the patients,not only increasing the financial burden,but also causing pain to the patient and family members.The diagnosis and treatment of IAFIF are relatively difficult,and there are few systematic etiological studies,so IAFIF has drawn much attetion from orthopedic surgeons.The authors summarize the clinical manifestations,etiological characteristics,research progress of IAFIF diagnosis and treatment,to provide reference for clinical practices.
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Objective To investigate the efficacy of anti-infective reconstituted bone xenograft (ARBX) combined with external fixation in the treatment of adult infective nonunion of humeral shaft.Methods A retrospective case series study was conducted to analyze the clinical data of 18 patients with infected nonunion of humeral shaft admitted to Xijing Hospital of Air Force Military Medical University from January 2014 to December 2016.There were 10 males and eight females,aged 19-62 years [(36.9 ± 11.8)years].According to Umiarov classification of infective nonunion,there were 11 patients with type Ⅲ and seven with type Ⅳ.All patients were treated with anti-infective reconstituted bone xenograft (ARBX) combined with external fixation.The number of operations,bone healing time,bone healing rate,infection control rate,postoperative weight bearing time,the time of external fixation removal,postoperative complications,erythrocyte sedimentation rate (ESR),and C-reactive protein (CRP) before and after operation were recorded.Fracture healing and functional recovery were evaluated using the Johner-Wruch lower limb function score.Results The patients were followed up for 12-30 months [(21.3 ±5.6)months].The operation was performed for (1.4 ±0.9) times,with time of bone healing for (16.6 ± 5.8)months,bone healing rate of 83％ (15/18),and infection control rate of 94％ (17/18).The postoperative weight bearing time in 15 patients who obtained bone healing was (3.3 ± 1.5)months after operation,and the external fixation removal time was (18.5 ± 4.2) months after operation.There were three patients with nonunion after operation including one with infection recurrence.Five patients were found with nail tract infection.ESR and CRP at postoperative 3 months [(13.1 ± 8.4)mm/h and (5.6 ± 4.6)mg/L] were significantly lower than those before operation [(47.3 ± 19.2)mm/h and (23.4 ± 7.4) mg/L] (P ＜ 0.05).According to Johner-Wruch lower limb function scores,the results were excellent in nine patients,good in four,fair in one,and poor in four,with excellent and good rate of 72％.Conclusion ARBX combined with External fixation can effectively treat infective nonunion of humeral shaft,improve bone healing rate,and promote function recovery.
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Objective@#To evaluate the effect of 3DBody software assisted problem-based learning (PBL) teaching in orthopedic teaching.@*Methods@#Undergraduates of clinical medicine from grade 2013 who had internship in our hospital were divided into experimental group and control group. Undergraduates in the experimental group were taught by 3DBody software assisted PBL teaching, with designed questions and the method of using 3DBody software handing to students before class. While undergraduates in the control group were taught by traditional teaching, with the use of textbooks and multimedia courseware. Examination scores of theory and probation were compared between the two groups. Questionnaires were used to evaluate the subjective perception of different teaching method among the participants in each group.@*Results@#Scores of theoretical examination in the experimental group (84.6±5.9) were higher than those in the control group (73.2±6.1); scores of probation examination in the experimental group (17.7±2.1) were significantly higher than those in the control group (12.7±1.9); the degree of satisfaction in the experimental group (9.2±0.8) was significantly higher than that in the control group (7.2±1.3); all differences were statistically significant (P<0.05).@*Conclusion@#3DBody software assisted PBL teaching can significantly improve the effectiveness of orthopedic teaching and enhance students' learning initiative and interest, which is worth promoting.
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Objective@#To establish an efficient classification and treatment system for limb long bone defects.@*Methods@#Based on the length of bone defect, soft tissue injury and wound infection, a new classification and treatment system was proposed with reference to Gustilo-Anderson classification for open fractures and Orthopedic Trauma Association (OTA) classification.@*Results@#We divided the limb long bone defects into 3 types, each of which was subdivided into 4 subtypes depending on concomitant soft tissue defect and/or infection. Type Ⅰ are bone defects less than 4 cm in length, including type Ⅰa (simple bone defects with a limited extent), type Ⅰb (bone and soft tissue defects), type Ⅰc (bone defects with infection) and type Ⅰd (bone defects with infection and soft tissue defects). Type Ⅱ are bone defects ranging from 4 to 10 cm in length, including type Ⅱa (simple bone defects with a large extent), type Ⅱb (bone and soft tissue defects), type Ⅱc (bone defects with infection) and type Ⅱd (bone defects with infection and soft tissue defects). Type Ⅲ are bone defects larger than 10 cm in length, including type Ⅲa (simple bone defects with a very large extent), type Ⅲb (bone and soft tissue defects), type Ⅲc (bone defects with infection) and type Ⅲd (bone defects with infection and soft tissue defects).@*Conclusion@#Our new classification and treatment system for long limb bone defects is more efficient and intuitive, facilitating clinical diagnosis and treatment of limb long bone defects.
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Objective To establish an efficient classification and treatment system for limb long bone defects.Methods Based on the length of bone defect,soft tissue injury and wound infection,a new classification and treatment system was proposed with reference to Gustilo-Anderson classification for open fractures and Orthopedic Trauma Association (OTA) classification.Results We divided the limb long bone defects into 3 types,each of which was subdivided into 4 subtypes depending on concomitant soft tissue defect and/or infection.Type Ⅰ are bone defects less than 4 cm in length,including type Ⅰa (simple bone defects with a limited extent),type Ⅰb (bone and soft tissue defects),type Ⅰc (bone defects with infection)and type Ⅰd (bone defects with infection and soft tissue defects).Type Ⅱ are bone defects ranging from 4 to 10 cm in length,including type Ⅱa (simple bone defects with a large extent),type Ⅱb (bone and soft tissue defects),type Ⅱc (bone defects with infection) and type Ⅱd (bone defects with infection and soft tissue defects).Type Ⅲ are bone defects larger than 10 cm in length,including type Ⅲa (simple bone defects with a very large extent),type Ⅲb (bone and soft tissue defects),type Ⅲc (bone defects with infection) and type Ⅲ d (bone defects with infection and soft tissue defects).Conclusion Our new classification and treatment system for long limb bone defects is more efficient and intuitive,facilitating clinical diagnosis and treatment of limb long bone defects.
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Objective To evaluate the effect of 3DBody software assisted problem-based learning (PBL) teaching in orthopedic teaching. Methods Undergraduates of clinical medicine from grade 2013 who had internship in our hospital were divided into experimental group and control group. Undergraduates in the experimental group were taught by 3DBody software assisted PBL teaching, with designed questions and the method of using 3DBody software handing to students before class. While undergraduates in the control group were taught by traditional teaching, with the use of textbooks and multimedia courseware. Examination scores of theory and probation were compared between the two groups. Questionnaires were used to evaluate the subjective perception of different teaching method among the participants in each group. Results Scores of theoretical examination in the experimental group (84.6 ±5.9) were higher than those in the control group (73.2 ±6.1); scores of probation examination in the experimental group (17.7 ± 2.1) were significantly higher than those in the control group (12.7 ±1.9); the degree of satisfaction in the experimental group (9.2 ±0.8) was significantly higher than that in the control group (7.2 ±1.3); all differences were statistically significant (P<0.05). Conclusion 3DBody software assisted PBL teaching can significantly improve the effectiveness of orthopedic teaching and enhance students' learning initiative and interest, which is worth promoting.
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Objective: To highlight the relationship between miR-503 and wound healing of diabetic foot ulcer (DFU). Methods: Microarray analysis was used to detect the dysregulated miRNAs between the DFU tissues and normal tissues. The expression of miR-503 in tissues and serum of patients with DFU was detected by qRT-PCR technique. Then, CCK-8 assay was applied to determine the cell proliferation. TUNEL assay was used for assessing the apoptosis of cells after treatment with miR-503. Possible correlation between miR-503 and fbillin1 (FBN1) was predicted according to data accessed on RNA22 website online, and was detected for confirmation by luciferase reporter assay. Results: Microarray analysis showed that miR- 503 was significantly decreased in the DFU tissues compared with normal tissues. While marked increase in the expression of miR-503 in tissues and serum of patients with DFU was confirmed by qRT-PCR technique. Then, CCK-8 assay indicated that transfection of miR- 503 mimic obviously accelerated the cell proliferation. However, TUNEL assays suggested that miR-503 mimic inhibited the apoptosis of cells to improve the survival of fibroblasts. Besides, miR-503 AMO played a role in fibroblasts of DFU tissues exactly countering to miR-503 mimic treatment. It was predicted that MiR-503 is a complementary to the FBN1 by RNA22. Besides, SiRNA-FBN1 promoted the proliferation, but brought down the apoptosis of fibroblasts. Conclusions: MiR-503 regulates the function of fibroblasts and wound healing of patients with DFU by targeting FBN1 directly which provids a novel and critical target for diagnosis and treatment of DFU.
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Objective:To highlight the relationship between miR-503 and wound healing of diabetic foot ulcer (DFU).Methods:Microarray analysis was used to detect the dysregulated miRNAs between the DFU tissues and normal tissues. The expression of miR-503 in tissues and serum of patients with DFU was detected by qRT-PCR technique. Then, CCK-8 assay was applied to determine the cell proliferation. TUNEL assay was used for assessing the apoptosis of cells after treatment with miR-503. Possible correlation between miR-503 and fbillin1 (FBN1) was predicted according to data accessed on RNA22 website online, and was detected for confirmation by luciferase reporter assay.Results:Microarray analysis showed that miR- 503 was significantly decreased in the DFU tissues compared with normal tissues. While marked increase in the expression of miR-503 in tissues and serum of patients with DFU was confirmed by qRT-PCR technique. Then, CCK-8 assay indicated that transfection of miR- 503 mimic obviously accelerated the cell proliferation. However, TUNEL assays suggested that miR-503 mimic inhibited the apoptosis of cells to improve the survival of fibroblasts. Besides, miR-503 AMO played a role in fibroblasts of DFU tissues exactly countering to miR-503 mimic treatment. It was predicted that MiR-503 is a complementary to the FBN1 by RNA22. Besides, SiRNA-FBN1 promoted the proliferation, but brought down the apoptosis of fibroblasts.Conclusions:MiR-503 regulates the function of fibroblasts and wound healing of patients with DFU by targeting FBN1 directly which provids a novel and critical target for diagnosis and treatment of DFU.
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Objective To investigate the clinical effect of Gamma 3 intramedullary nails for the treatment of unstable intertrochanteric fractures in the elderly. Methods A total of 36 elderly patients (aged over 70 years)with unstable intertrochanteric fractures (Evans type Ⅲ or above)treated with Gamma 3 intramedullary nails from January 2013 to December 2016 were followed up and analyzed. Results All patients were followed up for 6 to 12 months ,with an average of (9.4 ± 2.6) months. The fractures were healed in all patients ,and the healing time was between 10 and 18 weeks , with an average of 14 weeks. A mild type of coxa varus was found in 2 cases. According to the Harris hip score ,the curative effect was excellent in 24 cases ,good in 7 cases ,fair in 3 cases and poor in 2 cases. The excellent and good rate was 86.1% . Conclusions The gamma 3 intramedullary nail is an outstanding internal fixation tool for the treatment of unstable intertrochanteric fractures in the elderly ,with such advantages as minimal trauma ,short operation time ,firm fixation and few postoperative complications.
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Objective To prepare biphasic calcium phosphate/polyvinyl alcohol scaffolds by 3D printing at room temperature and explore the effect of 3D scaffolds on in vitro osteogenic differentiation of the bone marrow mesenchymal stem cells (BMSCs).Methods After biphasic calcium phosphate and polyvinyl alcohol solutions were mixed,the biphasic calcium phosphate/polyvinyl alcohol composite scaffolds were prepared by room temperature 3D printing combined with freeze drying technique.Non-printing scaffolds were prepared by injection molding.The surface microstructure,porosity,elastic modulus and hydrophilicity of the 2 sorts of scaffolds were measured.The cytological experiments were carried out in 3 groups (n =3):printed scaffold group,non-printed scaffold group and blank control group (no scaffold).After the BMSCs were seeded onto the scaffolds for 7 and 14 days,the 3 groups were compared in terms of cellular proliferation,alkaline phosphatase activity and expression levels of osteogenesis-related genes.Results 3D composite scaffolds with controllable pore size and porosity were prepared successfully,with an average porosity of 59.6％ ± 3.6％ and an average elastic modulus of 429.3 ± 54.3 kPa.After culture for 7 and 14 days,the cellular absorbance values in the printed scaffold group (0.987 ± 0.047 and 1.497 ± 0.076) were significantly higher than those in the non-printed scaffold group (0.767 ±0.063 and 1.181 ±0.098) (P ＜ 0.05) which were in turn significantly higher than those in the blank control group (0.532 ±0.046 and 0.895 ± 0.062) (P ＜ 0.05).After culture for 7 and 14 days,the ALP activity and expression levels of osteogenesis-related genes in the printed and non-printed scaffold groups showed no significant between-group differences (P ＞ 0.05),but were significantly higher than those in the blank control group (P ＜ 0.05).Conclusions Tissue-engineered composite biphasic calcium phosphate/polyvinyl alcohol scaffolds with controllable pore size and good connectivity can be prepared by freeze-drying and room temperature 3D printing techniques.Co-culture of the scaffolds and BMSCs in vitro promotes adhesion,proliferation and osteogenic differentiation of the cells.
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Objective To compare the effectiveness of expandable intramedullary nail(EIMN) versus locked compression plate (LCP) in the treatment of humeral shaft fractures of AO types A and B.Methods The clinical data were retrospectively analyzed and compared of the 44 humeral shaft fractures which had been treated between May 2012 and February 2016.There were 26 men and 18 women,from 23 to 66 years of age (average,41.5 years).By AO classification,22 cases were type 12-A and 22 type 12-B.EINM was used in 22 patients with an average age of 41.3 ± 1 1.7 years and LCP in 22 ones with an average age of 41.6 ± 10.3 years.The 2 groups were compared in terms of intraoperative blood loss,operative time,hospital stay,union time,union rate,Constant and Mayo scores at the final follow-ups,and complications as well.Results The 2 groups were compatible without significant differences in the preoperative demographic data (P ＞ 0.05).All the 44 patients were followed up for 10 to 18 months (average,12 months).The intraoperative blood loss (76.4 ± 18.66 mL),operative time (69.1 ± 13.2 min),incision length (5.8 ± 1.5 cm) and union time (13.2 ± 8.4 w) in the EIMN group were significantly better than those in the LCP group (138.6 ± 39.4 mL,96.4 ± 14.2 min,8.5 ± 1.4 cm and 18.4 ± 6.6 w,respectively) (P ＜ 0.05).There was also a significant difference between the 2 groups in the total complication rate[18.2％ (4/22) versus 50.0％ (11/22)] (P ＜0.05).No deep infection or should pain was observed in either group.Conclusions Inthe treatment of humeral shaft fractures of AO types 42-A and 42-B,compared with LCP,EIMN may have advantages of less intraoperative blood loss,operative time,union time and complications.The 2 methods are similar in hospital stay and final functional recovery of the should joint.
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Objective To compare the effect of proximal femoral intramedullary nail fixation and femoral retrograde intramedullary nail combined with hollow lag screw fixation in the treatment of ipsilateral femoral neck and shaft fractures.Methods Data of 42 patients with ipsilateral femoral neck and shaft fractures who were admitted in our hospital from January 2007 to January 2016 were retrospectively analyzed.According to different fixation methods,the patients were divided into two groups:single intramedullary nail group (SIN group) (20 cases,treated with single proximal femoral intramedullary nail,15 males and 5 females with an average age of 39.4);combined internal fixation group (CIF group) (22 cases,treated with femoral distal intramedullary nail combined with femoral neck hollow lag screw,17 males and 5 females with an average age of 42.2 years).In the SIN group,4 cases were type A,9 cases type B,7 cases type C according to AO classification.And 14 cases belonged to Ⅰ or Ⅱ (stable fracture),6 cases of type Ⅲ or Ⅳ (unstable fracture) according to Garden classification.In the CIF group,3 cases were type A,10 cases type B,9 cases type C according to AO classification.And 16 cases belonged to type Ⅰ or type Ⅱ,6 cases type Ⅲ or Ⅳ according to Garden classification.The incision length,operation time,intraoperative blood loss,fracture healing time,postoperative weight time,stability of internal fixation,hip function score,pain in the knee and postoperative complication rate were compared between the two groups.Results There was no significant difference in gender,age and fracture classification between the two groups.The operation time (75.0±10.2 min),intraoperative blood loss (150.6±80.4 ml),hip Harris score excellent rate (80％) of incidence of knee pain in postoperative 3 months (10.0％) of the SIN group were significantly lower than those of the CIF group (105.2±18.4 min,180.0±56.8 ml,86.4％ and 31.8％).The length of incision (8.3±1.4 cm) in the SIN group was significantly longer than that in the CIF group (4.0±0.6 cm).There was no significant difference in fracture healing time (SIN group 20.O±4.0 weeks,CIF group 19.6±4.2 weeks) and postoperative weight time (SIN group 8.2±4.0 weeks,CIF group 8.0±4.2 weeks) between the two groups.The main complications of the two groups were delayed union (3 cases of SIN group and 1 case of CIF group),nonunion of fracture (1 case of SIN group) and,coxa vara (1 case of SIN group).The complication of SIN group (30％) was significantly higher than that of CIF group (4.5％),which occurred mainly in unstable femoral neck fracture cases.Conclusion Both proximal femoral intramedullary nail fixation and femoral retrograde intramedullary nail combined with hollow lag screw can effectively treat femoral ipsilateral femoral neck and shaft fracture.Femoral retrograde intramedullary nail combined with hollow lga screw has more therapeutic advantages for unstable femoral neck fractures (Garden Ⅲ and Ⅳ).
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Objective To observe the long-term efficacy of anti-infective reconstituted bone xenograft (ARBX) combined with external fixation of posttraumatic long bone infection in lower extremities.Methods This retrospective case series study included 36 patients with posttraumatic long bone infection in lower extremities followed up for more than 18 months after receiving one-stage ARBX bone grafting combined with ring external fixation from January 2004 to December 2013.There were 21 male and 15 female patients,at the age of 19-72 years (mean,35.8 years).Multiple fractures were seen in 24 patients and single fractures in 12 patients.Bone and functional results were evaluated using the association for the study and application of the method of Ilizarov (ASAMI) classification.Results Follow-up ranged from 18 to 72 months (mean,38 months).Bone union was seen in 33 cases in a mean period of 5.2 months,and infection was completely cured.Length of limbs in all patients reached the expected extension length with the bone extension length of 3-10 cm (mean,5.2 cm).All the extended areas showed bone healing.According to the ASAMI classification,bone result was excellent in 20 patients,good in 13 and fair in 3,with the excellent and good rate of 92％,and limb function recovery was excellent in 18 patients,good in 11 and fair in 7,with the excellent and good rate of 81％.Conclusion ARBX adjuvant external fixator treatment of posttraumatic long bone infection in lower extremities improves bone healing rate and limb function recovery rate and shortens bone healing time at one stage.