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Objective To investigate the association between serum alkaline phosphatase (ALP) and type 2 diabetes mellitus (T2DM) with nonalcoholic fatty liver disease (NAFLD). Methods A total of 599 patients with T2DM who were hospitalized in Department of Endocrinology, Affiliated Hospital of Jiangsu University, from July 2016 to December 2018 were enrolled as subjects. According to the presence or absence of NAFLD, the patients were divided into NAFLD group with 286 patients and non-NAFLD group with 313 patients, and according to the results of abdominal ultrasound, the patients with NAFLD were divided into mild group with 111 patients, moderate group with 105 patients, and severe group with 70 patients. General clinical data were compared between groups. The independent samples t - test was used for comparison of normally distributed continuous data between two groups, and an analysis of variance was used for comparison between three groups; the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups, and the Kruskal-Wallis H test was used for comparison between three groups; the chi-square test was used for comparison of categorical data between groups. Pearson correlation analysis and Spearman correlation analysis were used to investigate the correlation between ALP and clinical indices, and a logistic regression analysis was used to investigate the influencing factors for NAFLD. Results Compared with the non-NAFLD group, the NAFLD group had significantly higher proportion of patients with history of hypertension ( χ 2 =7.864, P < 0.05), systolic blood pressure ( t =-2.226, P < 0.05), diastolic blood pressure ( t =-3.800, P < 0.05), body mass index (BMI) ( t =-11.842, P < 0.05), waist circumference (WC) ( t =-9.150, P < 0.05), fasting insulin (FINS) ( Z =-6.173, P < 0.05), fasting C-peptide ( t =-5.419, P < 0.05), serum uric acid ( t =-4.957, P < 0.05), low-density lipoprotein cholesterol ( t =-2.702, P < 0.05), triglyceride ( Z =-9.376, P < 0.05), total cholesterol (TC) ( t =-3.016, P < 0.05), Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) ( Z =-5.794, P < 0.05), alanine aminotransferase (ALT) ( Z =-6.737, P < 0.05), aspartate aminotransferase (AST) ( Z =-4.389, P < 0.05), gamma-glutamyl transpeptidase (GGT) ( Z =-7.764, P < 0.05), and ALP ( t =-2.833, P < 0.05), as well as significantly lower age ( t =2.184, P < 0.05) and high-density lipoprotein cholesterol ( Z =-5.273, P < 0.05). The severity of NAFLD (mild, moderate or severe) was positively correlated with age ( r s =0.140, P < 0.05), BMI ( r s =0.239, P < 0.05), WC ( r s =0.222, P < 0.05), FINS ( r s =0.191, P < 0.05), HOMA-IR ( r s =0.218, P < 0.05), ALT ( r s =0.188, P < 0.05), AST ( r s =0.279, P < 0.05), GGT ( r s =0.202, P < 0.05), and ALP ( r s =0.361, P < 0.05). In the patients with T2DM and NAFLD, ALP was positively correlated with HbAlc ( r =0.149, P < 0.05), fasting plasma glucose ( r =0.146, P < 0.05), HOMA-IR ( r s =0.132, P < 0.05), TC ( r =0.151, P < 0.05), ALT ( r s =0.210, P < 0.05), AST ( r s =0.192, P < 0.05), and GGT ( r s =0.297, P < 0.05). The logistic regression analysis showed that ALP was an influencing factor for NAFLD in patients with T2DM (odds ratio=1.013, 95% confidence interval: 1.004-1.023, P < 0.05). Conclusion Elevated serum ALP is a risk factor for T2DM with NAFLD and is closely associated with hyperglycemia, insulin resistance, and hyperlipemia, and ALP may play a role in the development and progression of T2DM and NAFLD.
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Objective To integrate the best available evidence of preoperative care for ophthalmic patients undergoing day surgery into clinical practice,so as to improve the quality of nursing.Methods This project was performed in an ophthalmic day surgery ward,guided by the Joanna Briggs Institute(JBI)Practice Application of Clinical Evidence System (PACES) program which includes 3 procedures:baseline audit,evidence implementation,and re-audit.Eight audit criteria were made based on evidences from JBI.Twelve nurses and 267 patients were enrolled in baseline audit,and 12 nurses and 234 patients were recruited for re-audit after evidence implementation.Results Six of the audit criteria that nurses showed poor compliance in the baseline audit(0％～28.5％),such as providing preoperative telephone screening and reducing preoperative waiting time through better preparation and planning,were significantly improved in the re-audit(71.43％～100％).The preoperative waiting time was shortened from 109.70±18.34 minutes to 88.22±9.91 minutes;the correct rates of operation-related knowledge in patients increased from 63.0％ to 85.09％;the patients' satisfaction scored 84.23±17.01 in baseline audit and 95.02±7.32 in the re-audit(P＜0.001).Conclusion Application of evidence-based preoperative care of ophthalmic patients undergoing day surgery can improve nurse's behavior and compliance with the implementation of evidence into clinical practice,and increase patient satisfaction.Continuous audits are needed to continuously improve clinical nursing quality.
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BACKGROUND:Staphylococcal infections and its biofilm formation can occur when orthopedic implants or wound is healing, and are regulated by bacterial population sensing mechanism. RNAIII inhibiting peptide intervenes the quorum-sensing system of staphylococcal and blocks the signal transduction among staphylococcal cells, and inhibits staphylococcal biofilm formation, and then prevents staphylococcal infections. OBJECTIVE:To investigate the influence of RNAIII inhibiting peptide on the adhesion of staphylococcus epidermis to the Hela cells. METHODS:The Hela cells were cultured in vitro. There were four groups in this study. In the blank group, saline with dimethyl sulfoxide was added in each wel . In the RNAIII inhibiting peptide group, dimethyl sulfoxide solution containing RNAIII inhibiting peptide was added. In the levofloxacin group, levofloxacin was added. In the combination group, the dose was in accordance with above methods. Using intergroup control method, the adhesion of staphylococcus epidermis to the Hela cells was compared under the effects of saline, RNAIII inhibiting peptide and levofloxacin and their combination. RESULTS AND CONCLUSION:In the blank group, abundant bacterial adhered to Hela cells. The number of adhered bacteria was significantly lower in each medicine group than in the blank group (P<0.001). The spot count was significantly lower in the levofloxacin group than in the RNAIII inhibiting peptide group (P<0.05). In the combination group, the number of bacteria adhered to Hela cells was decreased (P<0.01). Results verified that RNAIII inhibiting peptide effectively suppressed the adhesion of staphylococcus epidermis to the host cells, and showed synergistic effects on antibiotics.
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BACKGROUND:Alternative implants affect stability of prostheses,and freeze-dried bone allografts are most selected as implants.The crack between grafts and host bone is unavoidable,which would weaken the bone integration.Bone cement can fill the cracks quickly and completely,however,the effects of bone cement on the stress of prostheses and its own remains poorly understood.OBJECTIVE:To evaluate the effect of the different grafting for bone loss in the presence of the new acetabular component with wings at the time of acetabular revision.METHODS:The finite-element models of acetabular component with three wings and acetabulum with bone loss were established.Following prostheses implantation,the gaps were filled with bone cement and freeze-dried bone allograft,respectively,stress of the graft and its effect on prostheses were analyzed under 2 158 N and 426 N acetabular loads.RESULTS AND CONCLUSION:The finite-element analysis demonstrated that stress and strain at the interfaces of bone-shell and metal-polyethylene liner had the same direction of change but no significant difference between them.In the study,the result indicated increased contact stresses with an increased hip force and orientation.The stress of wings increased gradually from rim to root.Its peak stress was at the joint between the wing and the shell.The different grafts did not affect the stress of the acetabular component.But the stress of bone cement was significantly higher than that of particulate bone.The study demonstrated that change of the graft could not make remarkable effect on the stress of the acetabular component.But the stress of bone cement increased significantly.The result of the finite-element analysis indicated that particulate bone graft is benefit to improving itsstability and to minimize aseptic loosening rate of acetabular component.
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OBJECTIVE: To evaluate the histocompatibility of poly (lactic-co-glycolic acid)/RNA Ⅲ inhibiting peptide (PLGNRIP) sustained release microspheres.METHODS: The crude peptide comprising N to C-terminals was synthesized using Fmoc method. The crude synthetic RNAⅢ peptide was purified by reverse phase high performance liquid chromatography, followed by component harvesting according to ultraviolet absorption peak, and freeze-drying. PLGNRIP sustained release microspheres with a diameter of 50-70 pm were prepared using liquid-phase multiple emulsion method. The histocompatibility of PLGNRIP sustained release microscopes were preliminarily evaluated through the use of acute general toxicity test, MTT cytotoxicity test, intramuscular implantation test, sensitivity test, and pyrogen test.RESULTS: Acute general toxicity test results showed that all included animals survived and presented with no toxicosis reaction and obviously changed body mass. MTT cytotoxicity test results revealed that the average relative growth rate of cells from two eluents was over 85%, with cytotoxicity grade 1, which indicated no cytotoxicity. Intramuscular implantation tests showed that at 4 weeks after implantation of RiP powder or PLGNRIP microscopes, no obviously congested, degenerated, or necrotic tissue was observed. All RIP powder and a part PLGNRIP microscopes were degraded. Fibroblasts accounted for a large proportion in all cells. NO inflammatory cell infiltration, involving neutrophits and multinucleated giant celts, was observed. Sensitivity test rasults displayed that the average primary irritation index was 0.38, 0.33, arid 0.31 in the eluent stock solution, 2% dinitoflruorobenzene, and physiological saline-administerd groups, respectively. Pyrogen test results showed that fervescence of each rabbit in the experiment was under 0.5 ℃ and the sum of fervescence was under 1.3 ℃ .This is in coincidence with evaluation criteria of pyrogen test.CONCLUSION: PLGNRIP sustained release microspheras exhibit good histocompatibility.
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BACKGROUND:The main factors that influence revision of acetabular bone defects include evaluation of acetabular bone defects,reconstruction of acetabulum and appropriate acetabular cups used in revision.OBJECTIVE:The review from the three aspects will help to choose an appropriate cup in revision and to formulate the best revision protocols.METHODS:A computer-based online search of PubMed was performed for English articles published from January 1900 to June 2009 with the key words of acetabulum,revision,bone defect,in English and Chinese.Clinical studies published in core periodicals of the latest twenty years were reviewed.Articles regarding primary joint replacement,femoral prosthesis revision and animal experiments were excluded.RESULTS AND CONCLUSION:A total of 61 articles were analyzed,31 were excluded,and 30 mainly published in 5 years,were included.Reconstruction of acetabular bone structure,restoration of original rotation center of hip joint are key factors for repair.Moreover,appropriate prosthesis further benefits the repair effect.Bone transplantation for bone defect and cementedless prosthesis have become favorable methods for revision of acetabular bone defects.
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BACKGROUND: A new material of porous carbonated hydroxyapatite cement (PCHC) is discovered using foaming technique.The new material characterizes original solidification and forms porous structure.OBJECTIVE: To investigate the biomechanical effect of PCHC on repairing cancellous bone defect.METHODS: Among 30 New Land rabbits, 25 ones were considered as surgery group, whose bilateral condyles of femur was used to establish bone defect model (5.5 mm diameter and 12 mm depth). PCHC was implanted into the left side, which was considered as the experimental group, and carbonated hydroxyapatite cement (CHC) was implanted into the right side, which was considered as the control group. Another 5 rabbits were used as normal mechanical control group. Both PCHC and CHC were dip in simulated body fluid (SBF) to test mechanical intension. PCHC and CHC were then implanted into muscles of back in the surgery group. Rabbits Were-sacrificed after 2, 4, 8, 12, and 16 weeks postoperatively. Mechanical analysis was tested following intra-bone and intramuscular implantation, and compressive strength was then tested following dipping into SBF.RESULTS AND CONCLUSION: PCHC: Intra-bone mechanical strength was lower at 2 weeks, the lowest at 4 weeks, but then closed to intension of normal cancellated bone at 8 weeks, higher than normal cancellated bone at 12 weeks, and recovered to the level of normal cancellated bone at 16 weeks. CHC: Intra-bone strength was higher than that of PCHC at 2 weeks, decreased at 4 weeks, gradually increased at 8, 12, and 16 weeks, but still lower than intension of normal cancallated bone. Compressive strength of both PCHC and CHC was not changed following dipping in SBF; however, compressive strength was changed remarkably following intramuscular implantation. The results demonstrated that PCHC characterized by immobilization in situ and mechanical supporting. Thus it could be used for one kind of bone substitute material to repair the bone defect.
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Objective To analyze and evaluate a new acetabular revision component with three wings. Methods The finite-element models of a new acetabular component and acetabulum with bone loss were established to calculate the interface stresses during a normal gait cycle with use of the finite-element formulations. Results The finite-element analysis demonstrated that stress and strain at the interfaces of bone-shell and metal-polyethylene liner had the same direction of change but no remarkable difference between them. In the study, the result indicated increased contact stresses with an increased joint load and orientation. The peak stress was tested at the second stage of gait cycle. The stress of wings increased gradually from rim to root. Its peak stress that was significantly lower than yield force of the Co-Cr alloy was at the joint between the wing and the shell. The stress of graft had the same change rule as the joint force. The part of graft near to acetabular component was subjected to higher stress conditions. Conclusion The hip forces can transfer from acetabular component and implant to acetabulum. The result of the finite-element analysis underlined the importance of wings of the new acetabular component. The wing can help to improve the antitorsion ability of acetabular component and to minimize its aseptic loosening rate. Therefore, based on results of this study and clinical application, the acetabular component with wings is known a viable means for acetabular revision in the presence of bone loss. But further research is needed as to this acetabular component.
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Alternative designs have been explored in an attempt to improve the longevity of acetabular prostheses in revision surgery. Many studies had been designed to test the result of the extra-large uncemented hemispherical acetabular components used for acetabular revision in the presence of bone loss. A clinical study of a new acetabular component consisting of a porous metal shell with three wings and an all-polyethylene liner had attained a satisfying result. The purpose of this study was to evaluate the new acetabular component by comparison with the hemispherical acetabular component. The finite-element models of the two acetabular components and the acetabulum in the presence of bone loss were established to calculate the interface stresses during a normal gait cycle with use of the finite-element formulations. Results of the finite-element analysis demonstrated that stress and strain of the two acetabular components had the same direction of change, but the new component had higher stress at the root of wings. In the study, the result indicated reduced contact stresses with a reduced abduction angle of wings. The stress was lower in the new acetabular component of 15° angle of wings compared with the new acetabularcomponent of 30°of wings and hemispherical acetabular component (P < 0.05). The stress of acetabular component with wings showed no remarkable difference by comparison with the extra-large uncemented hemispherical acetabular component. Reducing abduction angle of wings seemed to be a viable means of reducing the stress of the acetabular component while improving its stability.
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BACKGROUND: The active component in recombinant human bone morphogenetic protein-2/poly(lactide-co-glycolide) (rhBMP-2/PLGA) microsphere prone to be absorbed or lost during solution with physiological saline, and the setting time is uncontrollable using blood solution, so it is necessary to explore an sustained-release carrier that can control the setting time.OBJECTIVE: To construct an injectable BMP release system by combing rhBMP-2/PLGA microsphere with fibrin glue. DESIGN, TIME AND SETTING: An experimental comparative study was performed at the Department of Othopaedics, General Hospital of Chinese PLA from January 2005 to April 2008.MATERIALS: PLGA (polylactic acid/polyglycolic acid 75/25, M_r=3 000, with 0.025 L/g viscosity) was supplied by Shandong Institute of Medical Instruments; rhBMP-2 was offered by The Academy of Military Medical Sciences; and fibrin glue was supplied by Hangzhou Puji Medicine Technology Development Co., Ltd.METHODS:The rhBMP-2/PLGA microsphere was prepared using W/O/W solvent evaporation methods. rhBMP-2 loaded PLGA microsphere were incorporated in fibrin glue to establish injectable BMP release system.MAIN OUTCOME MEASURES: The setting time,release behaviors, electron spectroscopy for chemical analysis (ESCA) as well as pH values of composites were measured.RESULTS:①Compared with fibrin glue, the setting time of composites were slightly increased.②Initial burst release of the composites occurred, the drug release exceeded 16.76% within 2 days, and 76.75% of the drug was release within 42 days. ③ESCA showed that composites prolonged release times.④The PH value of composites was between microsphere and fibrin glue.CONCLUSION: RhBMP-2/PLGA microsphere/fibrin glue composite has satisfactory slow-release effect and syringeability, which not only degrade partial acid environment but also maintain the biological effect of higher density. Therefore, it forms a promising synthetic bone graft.
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OBJECTIVE: To evaluate blood compatibility of polyaiticglycolic acid/RNA Ⅲ inhibiting peptide (PLGA/RIP) delayed release microspheres.METHODS: ① Preparation of PLGA/RIP microspheres: The solid-phase synthesis (Fmoc) method was used to synthesize RIP crude sample from C end to N end; the synthesized crude peptide was purified by the reverse phase high performance liquid chromatography. According to UV absorption peak, the components were collected and freeze-dried, to obtain RIP purifications. Then liquid-phase multiple emulsion method was used to prepare PLGA/RIP microspheres at the diameter of 50-70 μm. ② Preparation of eluent: The PLGA/RIP microsphere powders were eluted with sterile physiological saline at 37 ℃, to prepare 1 g/L eluent; then 0.5 g/L eluent was obtained adding equal volume of sterile physiological saline. The hemolysis test, blood clotting test, and platelet aggregation test were conducted to measure prothrombin time and activated partial thromboplastin time, to observe the influence on rabbit leucocytes, erythrocytes and thrombocytes, and to preliminarily evaluate the blood compatibility of PLGA/RIP microspheres. RESULTS: ①The haemolysis rates of eluent stock solution and 0.5 g/L eluents were 3.24% and 2.67% respectively, which were in coincidence with the criteria of medical biomaterials, less than 5%. ② The eluent stock solution and 0.5 g/L eluents of PLGA/RIP microspheres had no significant effect on rabbit clotting time, prothrombin time and activated partial thromboplastin time, the number of rabbit leucocytes, erythrocytes and thrombocytes, as well as platelet aggregation.CONCLUSION: PLGA/RIP delayed release microspheres have a good blood compatibility.
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AIM: RNAⅢ inhibiting peptide (RIP) has been previously proved to possess good histocompatibility and safety for preventing and curing staphylococcal infection, and this study evaluated histocompatibility of polyaiticglycolic acid/RIP (PLGA/RIP) sustained release microsphere. METHODS: The experiment was performed in the Orthopedic Institute, Pharmacologic Research Institute and Animal Experimental Center of General Hospital of Chinese PLA from October 2005 to October 2007.①Preparation of PLGA/RIP: The solid-phase synthesis (Fmoc) method was used to synthesize RIP from C end to N end, then the synthesized peptide was purified by the reverse phase high performance liquid chromatography, and composition was collected by means of ultraviolet absorption peak. The purified RIP was obtained after freezing and drying. Liquid-phase multiple emulsion method was used to synthesize PLGA/RIP microsphere of 50-70 ?m diameter.②Acute general toxicity test was studied in PLGA/RIP. Effect of PLGA/RIP on the cell proliferation was detected with cytotoxicity test by MTT method. Intramuscular implanting test was used to observe the irritation reaction of muscles by implantation materials. Sensitivity test was used to observe the sensitization of PLGA/RIP. Changes of animal's body temperature were determined with pyrogen test. RESULTS: ①Acute general toxicity test: Neither toxicosis reaction nor animal death was found after animals were injected with 100% and 50% eluents of PLGA/RIP peritoneally. Animal's body weight was not changed significantly.②Cytotoxiciity test by MTT method: The average proliferation rate of cell in two kinds of eluents exceeded 85% and cytotoxicity was graded in 1 rank, indicating no cytotoxicity.③Intramuscular implanting test: At 4 weeks after RIP and PLGA/RIP were implanted into the animals, there was not obvious synathresis, denaturation or necrosis in tissues. No inflammatory cell infiltration occurred around the materials. There had been the fibrous capsules around the materials.④Sensitivity test: Average primary irritation index of three groups were 0.38, 0.33 and 0.31 respectively. There was no significant difference among three groups.⑤Pyrogen test: Fervescence of each animal in the experiment was under 0.5 ℃, confirming that the materials had no pyrogenic characteristics. This was in coincidence with evaluation criterion of pyrogen test. CONCLUSION: PLGA/RIP has good histocompatibility and safety, without general toxic reaction, cytotoxicity, immunological rejection, hypersensitive response or pyrogenic characteristics.
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AIM:To explore the surgical effect of total hip joint replacement on the severe degenerative arthritis secondary to congenital hip dysplasia.METHODS:The experiment was carried out in the Department of pedics,General Hospital of Chinese PLA between June 1998 and December 2005.①116 adult patients(128 hips) with arthritis secondary to dysplastic hip received total hip replacement,including 13 males(15 hips) and 113 females(106 hips),aged from 16 to 66 years(average of 42.6 years).According to Crowe classification system,there were 57 cases(60 hips) of typeⅠ,20(23 hips) of typeⅡ,16(20 hips) of type Ⅲ and 23(25 hips) of type Ⅳ.②The acetabula were reconstructed at the true acetabular location.Except one case,all patients were given biological fixation of cementless acetabular cups including 83 hips with routine total hip replacement,and 27 hips with smaller cup;11 hips with routine total hip replacement after granular bone grafting,and 7 hips with a smaller cup after autologous femoral grafting on the superior margin of acetabula.119 biological prostheses were used to reconstruct the femoral cups including 4 common cemented shafts,6 long cemented shafts,and 4 S-ROM prostheses.③Harris hip score was adopted to evaluate the hip function,and X-ray photographs were used to observe the location of prostheses.RESULTS:①The Harris hip scores increased from 38.5 preoperatively to 88.5 postoperatively.②No prosthesis displacement,dislocation of hip joint or repair was found in patients,and the length of treated limbs meanly prolonged by 2.3 cm.Additionally,the incision healed primarily.③Radiographically,the positions of the prostheses were normal,and the bone grafts fused with the host bone successfully.The average bone coverage was 95%(90%-100%);radiolucentline was observed at between the acetabular cup and host acetabula in 2 cases,and 1 at femur.④Adverse effects:Sciatic nerve tension injury was found in 1 case and recovered in 4 months,the femoral nerve tension injury in 1 case and recovered in 3 months,and hip rest pain remained in 4 cases.CONCLUSION:In the treatment of arthritis secondary to dysplastic hip with total hip replacement,it is better to reconstruct the acetabulum at the true acetabular location.Moreover,the individualized appropriate selection of femoral prostheses is a key factor to obtain good curative effects.
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BACKGROUND: Carbonated hydroxyapatite cement (CHC) s a new kind of biomaterial for bone defect, which is made of powder and fluid, and can be mixed to be pasty to repair various bone defects.OBJECTIVE: To observe the improvement of vertebrae height and pain in patients with osteoporosis vertebral compression fracture (VCF) after vertebroplasty by using a new kind of bone graft biomaterial, taking CHC as the filling material to reinforce the vertebral body.DESIGN: A contrast observation trial taking patients as subjects.SETTING: Department of Orthopaedics, General Hospital of Chinese PLA.PARTICIPANTS: Totally 34 patients with thoracic or lumbar osteoporosis VCF who received the treatment in the Department of Orthopaedics, General Hospital of Chinese PLA between October 2000 and August 2003. Inclusive criteria: ①Definite diagnosis by CT; ② Informed consents were obtained from the patients. Exclusive criteria: The patients with osteoporosis vertebral compression fractures who suffered vertebral posterior wall fracture. There were 6 males and 28 females, and they were aged (72±13)years; Among the patients, 27 were diagnosed as postmenopausal osteoporosis, 1 as cortical hormone-induced osteoporosis and 6 male patients weresenile osteoporosis.METHODS: ①All the patients were randomly divided into two groups: Experimental group (n =23) and control group (n=11). All the patients were performed percutaneous operation with local anesthenia. All cases were performed percutaneous operation under local anesthesia. Under the C-arm monitored, one side pedicle puncture was performed to enter the anterior column of the involved VCF. Patients of the experimental group were filled with CHC. Patients of control group were filled with polymethyl Methacrylate (PMMA) with the same way. ② Referred to McGill-Melzack scoring. Among the scale 0-100 mm (0 was no pain, 100 was acute pain), the value indicated the painful intensity and mental assault degree. ＜ 30 scores indicated good, 30-40 basically satisfied and ≥ 50 poor .③ Referred to the method from Lee et al, the preoperative height (A1) and postoperative height (A2) of compression fracture position of VCF were measured according to the lateral X-ray film. At the same time, the upper vertebral height (A3) and the inferior vertebral height (A4) were measured at the same position. The original height (A) of the involved vertebra was calculated as (A)= (A3+A4)/2,and the preoperative vertebral compression rate =(A-A1 )/A, the postoperative vertebral compression rate =(A-A2)/A, the restoring rate = (the preoperative vertebral compression rate-the postoperative vertebral compression rate)/the preoperative vertebral compression rate. ④ The wounds of the patients were observed after operation. The levels of blood routine, serum calcium and serum phosphorus were detected before, one day and one week after operation. MAIN OUTCOME MEASURES: ① Preoperative and postoperative VAS scoring. ② The vertebral compression rate and restoring rate. ③ Wounds were observed after operation. The blood routine, the serum calcium and serum phosphorus were detected before, one day and one week after operation.RESULTS: Totally 34 patients were involved in the result analysis. ①The preoperative visual analogue scale (VAS) score of experimental group were (91.5±21.7) points, and the postoperative ones were (44.5±27.2) points. The difference of VAS score reduced gradually along with the postoperative time. There was no difference of VAS score between experimental group and the control group 4 weeks after operation. ② The biocompatibility of CHC in the vertebral body was fine. The vertebral compression rate of experimental group was recovered from (43.1±21.4)％ preoperatively to (27.3± 18.5)％ postoperatively. The rate of restored heights was (27.3±18.5)％. ③ All patients obtained Ⅰ stage wound healing, and none of them had infection, inflammatory secretion and nervous symptom. There were no differences in blood routine test, serum calcium, serum phosphorus between patients in two groups. One case filled by PMMA and two cases filled by CHC presented leakage, and none had nervous symptom.CONCLUSION: As the filling materials for vertebropalsty, CHC can restore the vertebral heights and relieve pain safely and effectively, however, its efficacy to relieve pain is not significant as PMMA in the short term.
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OBJECTIVE:To evaluate the histocompatibility of poly(lactic-co-glycolic acid)/RNA Ⅲ inhibiting peptide(PLGA/RIP)sustained release microspheres.METHODS:The crude peptide comprising N to C-terminals was synthesized using Fmoc method.The crude synthetic RNAIII peptide was purified by reverse phase high performance liquid chromatography,followed by component harvesting according to ultraviolet absorption peak,and freeze-drying.PLGA/RIP sustained release microspheres with a diameter of 50-70?m were prepared using liquid-phase multiple emulsion method.The histocompatibility of PLGA/RIP sustained release microscopes were preliminarily evaluated through the use of acute general toxicity test,MTT cytotoxicity test,intramuscular implantation test,sensitivity test,and pyrogen test.RESULTS:Acute general toxicity test results showed that all included animals survived and presented with no toxicosis reaction and obviously changed body mass.MTT cytotoxicity test results revealed that the average relative growth rate of cells from two eluents was over 85%,with cytotoxicity grade 1,which indicates no cytotoxicity.Intramuscular implantation tests showed that at 4 weeks after implantation of RIP powder or PLGA/RIP microscopes,no obviously congested,degenerated,or necrotic tissue was observed.All RIP powder and a part PLGA/RIP microscopes were degraded.Fibroblasts accounted for a large proportion in all cells.No inflammatory cell infiltration,involving neutrophils and multinucleated giant cells,was observed.Sensitivity test results displayed that the average primary irritation index was 0.38,0.33,and 0.31 in the eluent stock solution,2% dinitoflruorobenzene,and physiological saline-administerd groups,respectively.Pyrogen test results showed that fervescence of each rabbit in the experiment was under 0.5℃ and the sum of fervescence was under 1.3℃.This is in coincidence with evaluation criteria of pyrogen test.CONCLUSION:PLGA/RIP sustained release microspheres exhibit good histocompatibility.
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OBJECTIVE To determine the feasibility of clindamycin-loaded calcium phosphate cement(CLCPC) as a local antibiotic delivery system.METHODS The initial setting time(tI) and the final setting time(tF) were measured for 0%,2% and 5% CLCPC according to ASTM C266-89 method.Clindamycin concentrations eluting from the samples of 2% and 5% CLCPC in PBS were analyzed by HPLC at different times.The bacteriostasis tests were done by plate diffusion method for 2% and 5% CLCPC and 2% Palacos R-40 bone cement(PMMP) samples,and the diameters of the bacteriostasis ring and bacteriostasis duration were observed.The setting product and crystal size of 0%,2% and 5% CLCPC were analyzed and observed by X-ray diffraction(XRD) and scanning electron microscopy(SEM).RESULTS The setting time could be shortened by adding clindamycin(tI,tF) of 2% and 5% CLCPC.Clindamycin was with burst-release from CLCPC within the intial 6-hour period and the release rate slowed down on 4th day.Clindamycin could still release until to the 42th day.The ring of 2% Palacos R-40 bone cement(PMMP) bacteriostasis was smaller than that of 2% CLCPC,and the ring of 2% CLCPC bacteriostasis was smaller than that of 5%CLCPC.The bacteriostasis still existed to the 42th day of test for 2% and 5%CLCPC and 2% Clindamycin-loaded Palacos R-40 bone cement(CLPMMP).From the 30th day,many bacterial colonies were seen in the culture media laying 2%CLPMMP sample.On the contrary,bacterial colony was not found in the media putting 2% and 5%CLCPC.XRD and SEM showed that clindamycin did′t have an influence on setting product,crystal size and structure of CPC.CONCLUSIONS Clindamycin-loaded calcium phosphate cement can be used as a local antibiotic delivery system.
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OBJECTIVE To investigate the in vitro effect of 4 kinds of implant materials on the biofilm formation of Staphylococcus epidermidis.METHODS S.epidermidis was cultured,purified and identified.Susceptibility test was done for S.epidermidis and the ability to produce biofilm was proven.The test samples were made into wafer shape for titanium alloy,Co-Cr-Mo alloy,ultrahigh molecular weight polyethylene(UHMWPE)and home-made polymethyl methacrylate(PMMA).S.epidermidis was cultured with 4 kinds of test samples for 5 days respectively.Bacteria adhering on surfaces of 4 kinds of test samples were dissolved with trypsin,and then diluted into bacterial suspensions.Each bacterial suspension was inoculated quantitatively and CFU were counted.Biofilm on surfaces of 4 kinds of test samples prepared by vacuum drying method was observed with SEM.RESULTS The strain proven to be S.epidermidis,was resistant to semisynthetic penicillins,and could produce biofilm.CFU count showed that CFU were the most on the UHMWPE surface and the number of CFU were(24.96?1.459)?105.CFU were(17.44?1.883)?105 on the PMMP surface.(0.424?0.065)?105 CFU were discovered on the surfaces of titanium alloy and(0.382?0.075)?105 CFU on Co-Cr-Mo alloy.When each group compared with UHMWPE and domestic PMMA respectively,all P value was
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[Objective]To study the influence of hydroxypropyl methyl cellulose(HPMC) on injectability of calcium phosphate cements(CPC).[Method]Calcium phosphate cement(ICPC) with different content of HPMC(0～4%) was prepared.Injectability coefficient and consistency were tested to evaluate the injectability of the cements.[Result]Injectability increased as HPMC content increased.CPC injectability coefficient reached to 95% with lowest consistency when HPMC increased to 2%.CPC with 2% HPMC could be injected from syringe completely.Injectability began decrease when HPMC beyond 3%.Injectability decreased to 90% as HPMC increased to 4%,2% HPMC increased the injectability and decreased the consistency significantly,without any influence of setting time.[Conclusion]Rheology and injectability of CPC can be improved by HPMC significantly,Injection of CPC with 2% HPMC can be used for mini-invasive orthopedic surgery.
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@#ObjectiveTo observe the effect of rabbit skeletal muscle stem cells (RSMSCs) modified by adenovirus mediated bone morphogenetic protein-2 (BMP-2) gene ex vivo in combination with demineralized bone matrix (DBM) on repair of longer bone defect in rabbit.MethodsModel of radial bone defects (20 mm) of rabbits was established. 50 rabbits were divided into 5 groups, group A (AdrhBMP-2 trusduced RSMSCs/DBM group), group B (adGFP trusduced RSMSCs/DBM group), group C (not trusduced RSMSCs/DBM group), group D (DBM group), and group E (untreated group). Roentgenographic, histologic, biomechanical, bone density of all animals were examined at the end of 4th and 6th week after surgery.ResultsAt 4th week, radial bone defects healed in group A. The healing rates from group A to group E were 100%, 50%, 33%, 0%, and 0% respectively at 6th week.ConclusionRSMSCs modified by AdrhBMP-2 ex vivo in combination with DBM can repair radial longer segemental defect in rabbit. It's possible to be used in the clinical treatment of longer segemental bone defect.
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BACKGROUND: Carbonated hydroxyapatite cement is a new type material for skeletal repair and hydroxyapatites have been applied in the clinical treatment of skeletal defect.OBJECTIVE: To observe the effective characteristics of carbonated hydroxyapatite cement on repair of skeletal defect by animal experiment.DESIGN: Paired design, self-controlled and verified experiment was applied in the research.SETTING: Orthopedic Institute and Animal Experimental Center of Chinese PLA.MATERIALS: The experiment was performed in Orthopedic Institute and Animal Experimental Center of Chinese PLA from May 2002 to January 2003, in which, 10 healthy adult male mongrel dogs were applied, body mass weighted varied from 20 to 22 kg.METHODS: Animal model of skeletal defect was prepared on proximal ends of humeri of 10 mongrel dogs thydroxyapatitet were randomized into experimental side and control side. Ceramics repair of skeletal defect was done by carbonated hydroxyapatite cement and high-temperature sintered hydroxyapatite respectively. The animals were sacrificed on the 5th day, 4th, 8th, 12th and 16th weeks successively after operation. The repair effects were performed with X-ray and histological observation.staining.Results of stereomicroscopic and X-ray observations on bilateral skeletal defect: Osseointegration with carbonated hydroxyapatite cement was tight on the experimental side and the interface became unclear gradually with time lasting. The interface between hydroxyapatite and bone was still clear on the and eosin staining and thydroxyapatitet of ground bone with Gimsa staining:On the 8th week on the experimental side, the new bone grew into carbonated hydroxyapatite cement, on the 16th week, the two parts were intermixed and integrated and the bone island was formed around newly generated vessels in carbonated hydroxyapatite cement. On the control side, hydroxyapatite still maintained integrated and the bone interface was clear between hydroxyapatite and bone. On the 16th week, the aggradation of newly generated bone presented on hydroxyapatite surface.CONCLUSION: Carbonated hydroxyapatite cement possesses solidification property in situ, biocompatibility and osseous conductive activity. It is the satisfactory new type material for repair of skeletal defect.