Effect of single locked-plate internal fixation combined with autogenous iliac bone graft in the treatment of Rorabeck type II periprosthetic distal femoral fracture after total knee arthroplasty / 中华创伤杂志

Objective:To investigate the efficacy of single locked-plate internal fixation combined with autologous iliac bone graft in the treatment of Rorabeck type II periprosthetic distal femural fracture (PDFF) after total knee arthroplasty (TKA).Methods:A retrospective case series study was made on 13 patients suffering from Rorabeck type II PDFF after primary TKA together with severe osteoporosis (T value≤ -2.5 SD) admitted to 940th Hospital of Joint Logistics Support Force of PLA from January 2016 to December 2020, including 4 males and 9 females, aged 65-85 years [(75.2±6.5)years]. All patients were treated with single locked-plate internal fixation combined with autologous iliac bone graft. Anti-osteoporosis and early standardized joint function rehabilitation were undertaken postoperatively. The operation time and intraoperative blood loss were recorded. The range of motion of knee joint was compared before operation, at postoperative 3, 6 and 12 months and at the last follow-up. The Hospital for Special Surgery (HSS) knee score was assessed at postoperative 3, 6 and 12 months and at the last follow-up to evaluate the recovery of knee joint function. The bone mineral density was reexamined at postoperative 6 months and 12 months to evaluate the therapeutic effect of anti-osteoporosis. Complications were detected as well.Results:All patients were followed up for 12-72 months [(43.2±19.9)months]. The operation time was 90-135 minutes [(103.8±12.6)minutes], with the intraoperative blood loss of 100-250 ml [(150.0±45.6)ml]. The range of motion of knee joint was (114.6±7.8)°, (90.4±8.0)°, (97.3±4.8)° and (98.1±6.3)° before operation and at postoperative 3, 6 and 12 months (all P<0.05). The HSS knee score was (80.2±2.2)points, (84.6±2.9)points and (87.3±3.3)points at postoperative 3, 6 and 12 months (all P<0.05). The knee joint function was excellent in 10 patients and good in 3 at postoperative12 months, and the excellent and good rate was 100%. The T value of bone mineral density was (-3.8±0.6)SD, (-3.4±0.6)SD and (-2.9±0.6)SD preoperatively and at postoperative 6 months and 12 months (all P<0.05). One patient experienced nonunion and was cured after secondary autologous iliac bone grafting combined with recombinant human bone morphogenetic protein-2 (rhBMP-2) bone grafting. Three patients developed venous thrombosis of lower limbs and were cured with oral administration of rivaroxaban. One patient had mild knee flexion and extension limitation and was improved after manual release under femoral nerve block anesthesia and subsequent functional rehabilitation. Conclusion:For patients with Rorabeck type II PDFF after TKA, single locked-plate internal fixation combined with autologous iliac bone graft has advantages of short operation time, few intraoperative bleeding, satisfactory knee range of motion and functional recovery as well as significant improvement of bone mineral density.

Effect of Weiwei Tongtiao Decoction on Expression of IKKβ, Bcl-2 in CAG Precancerous Lesion Rats / 中国实验方剂学杂志

Objective:To investigate the effect of Weiwei Tongtiao decoction on gastric mucosal pathology and the expression level of inhibitor kappa B kinase <italic>β</italic>（IKK<italic>β</italic>） and B-cell lymphoma-2（Bcl-2）in rats with chronic atrophic gastritis （CAG） precancerous lesion. Method:SD rats were randomly divided into normal group， model group， positive drug Weifuchun group， Weiwei Tongtiao decoction high， medium and low dose treatment groups. The rat model of CAG precancerous lesion was prepared by <italic>N</italic>-methyl-<italic>N</italic>'-nitro-<italic>N</italic>-nitrosoguanidine （MNNG）compound modeling method. weiwei Tongtiao decoction high， medium and low dose treatment groups received intragastric administration of 24， 12， 6 g·kg^-1 Weiwei Tongtiao decoction respectively， while Weifuchun group received 0.45 g·kg^-1 Weifuchun suspension， once per day for 12 weeks. The pathological changes of gastric mucosa of rats were observed by hematoxylin-eosin（HE）staining， and the mRNA and protein levels of IKK<italic>β</italic> and Bcl-2 in gastric mucosa of rats were detected by Real-time quantitative polymerase chain reaction （Real-time PCR）， immunohistochemistry（IHC）and Western blot. Result:Compared with the normal group， 100% inherent gland atrophy， mild to severe intestinal metaplasia， and 25% low-grade intraepithelial neoplasia were observed under microscope in model group. All Weifuchun group and Weiwei Tongtiao decoction groups could improve the atrophy of gastric glands， moderate to severe intestinal metaplasia and pathological injury of low-grade intraepithelial neoplasia， especially at high dose group. Compared with the normal group， IKK<italic>β</italic>， Bcl-2 mRNA and protein expressions in the gastric mucosa of the model group were up-regulated （<italic>P</italic><0.01）. Compared with the model group， the mRNA and protein expressions of IKK<italic>β</italic> and Bcl-2 in gastric mucosa of rats in the Weifuchun group and the Weiwei Tongtiao decoction high， medium and low dose groups were down-regulated （<italic>P</italic><0.05，<italic>P</italic><0.01）， showing a dose-dependent relationship， and such levels in the Weiwei Tongtiao decoction high-dose intervention group were similar to those in normal group. Conclusion:Weiwei Tongtiao decoction can improve and even reverse gastric mucosa with CAG precancerous lesions in rats， and its intervention mechanism may be related to down-regulating the expressions of IKK<italic>β</italic> and Bcl-2 in gastric mucosa.

Study on fragmentation patterns of coumarins in Notopterygium inchum with ultrahigh performance liquid chromatography combined with quadrupole time-of-flight mass spectrometry / 中国中药杂志

To demonstrate the fragmentation patterns of simple coumarins furanocourmarin(C_7-C_8), furanocourmarin(C_6-C_7) and dihydrofuran coumarin by mass spectrometry, with fraxin, scopoletin, isopsoralen, pimpinellin, isoimperatorin, notopterol and noda-kenin as study subjects, so as to provide a basis for rapid identification of compounds in different subtypes of coumarins. Ultrahigh performance liquid chromatography combined with quardrupole time-of-flight mass spectrometry(UPLC-Q-TOF-MS) was implemented in both positive and negative ion modes. Masslynx software was employed to provide the elemental constituents of each detected ion based on its accurate molecular weight. Chemdraw 2014 was used to cultivate mass number of each inferred structure. The fragment pattern of each compound was determined based on the structures inferred from all the relevant ions. And the patterns were drawn by Chemdraw 2014. The deviation between the calculated molecular weight of the inferred structure and the detected value of the ions was used to assess the correctness of the inferred structures in the fragmentation patterns. The results showed that with UPLC-Q-TOF, neutral loss of CO_2 and CO was reflected in lactone and furan skeletons from the courmarin structure. An even mass was attributed to the loss of an odd number of methyl radicals from compounds with a methoxy substituent. Furanocourmarin(C_7-C_8) produced a protonated molecular ion([M+H]~+), while the other courmarin subtypes produced either a sodium adduct of the molecular ion([M+Na]~+) or a sodium adduct of the molecular ion([M+Na]~+) with a protonated molecular ion([M+H]~+). The m/z 203.03 was a diagnostic ion for furanocourmarin(C_6-C_7), and the m/z 147.04 was supplementary evidence for furanocourmarin(C_6-C_7) identification. The characteristic ion of furanocourmarin(C_7-C_8) was m/z 131.05, while m/z 187.04 was the characteristic ion of dihydrofuran coumarin. The m/z 203.03 ion for furanocourmarin(C_7-C_8) was pretty weak. In negative ion mode, furanocourmarin(C_7-C_8) did not have any signals that were different from the other subtypes of courmarins. The fragmentation patterns in negative ion mode for the other subtypes of courmarins were similar to those in positive ion mode. Four types of fragmentation patterns were identified as forcourmarins from Notopterygium inchum. This study provides the basis for the rapid identification of courmarin subtypes by mass spectrometry.

Advances on research of physical environment affecting stem cell differentiation in ligament tissue engineering / 中国骨伤

Ligament tissue engineering is currently a novel approach to the treatment of ligament injury, which can replace the deficiency of autografts. Ligament tissue engineering consists of four basic elements:seed cells, nanoscaffolds, growth factors, and mechanical stimulation. At present, the main problem in ligament tissue engineering is how to control seed cells to ligament cells more controllly. The study found that each physical property of the natural bio ligament and mechanical stimulation (uniaxial stretching) plays an important role in the differentiation of stem cells into ligament cells. Therefore, the design of nanofiber scaffolds must consider the elastic modulus of the material and the material. Structure(material arrangement, porosity and diameter, etc.), elastic modulus and material structure in different ranges will guide cells to differentiate into different lineages. Considering that the ligament is the main force-bearing tissue of the human body, mechanical stimulation is also essential for stem cell differentiation, especially uniaxial stretching, which best meets the stress of the ligament in the body. A large number of studies have found the frequency and amplitude of stretching. And time will also lead the cells to differentiate in different directions. RhoA/ROCK plays a regulatory role in cytoskeletal remodeling and cell differentiation. It is also found that RhoA/ROCK protein participates in the process of nanofiber arrangement and uniaxial stretching to guide stem cells to differentiate into ligament cells, specifically how to influence stem cell differentiation. It is not clear at present that understanding the effects of physical properties on stem cell differentiation and understanding the mechanism of action of RhoA/ROCK protein will provide a new theoretical basis for further optimization of ligament tissue engineering.

Effect of Addition and Subtraction Therapy of Xiaoyaosan Combined with Simotang to Gut-brain Axis of Patients with Irritable Bowel Syndrome with Predominant Constipation and Syndrome of Stagnation of Liver Qi / 中国实验方剂学杂志

Objective:To observe clinical effect of addition and subtraction therapy of Xiaoyaosan combined with Simotang to irritable bowel syndrome with predominant constipation （IBS-C） and syndrome of stagnation of liver Qi and to study influence to gut-brain axis. Method:One hundred and forty-four patients were randomly divided into control group （72 cases） and observation group （72 cases） by random number table. The 66 patients in control group completed the therapy （2 patients were falling off or missing visit， 5 patients were eliminate）， 65 patients in observation group completed the therapy （4 patients were falling off or missing visit， 2 patients were eliminate）. Patients in control group got Simotang， 20 mL/time， 3 times/day. In control group， patients in observation group added addition and subtraction therapy of Xiaoyaosan combined with Simotang， 1 dose/day. And courses of treatment in two groups were 4 weeks. Before and after treatment， degree of abdominal pain， irritable bowel syndrome （IBS） symptom severity scale （IBS-SSS）， quality of life in irritable bowel syndrome （IBS-QOL）， syndrome of stagnation of liver Qi， scores of Hamilton anxiety scale-14（HAMA-14）， Hamilton depression scale-17（HAMD-17）， complete spontaneous bowel movement （CSBM）， response rate of abdominal pain and defecation， remission rate of IBS-SSS were all recorded. And levels of vasoactive intestinal peptide （VIP）， substance P （SP）， neuropeptide Y （NPY）， 5-hydroxytryptamine （5-HT）， somatostatin （SS） and calcitonin related gene peptide were detected， and safety was evaluated. Result:Degree of abdominal pain， scores of IBS-SSS， syndrome of stagnation of liver Qi ， HAMA-14， HAMD-17 and levels of VIP， NPY， 5-HT， SS and CGRP in observation group were all lower than those in control group （P<0.01）. And times of CSBM， score of IBS-QOL and level of SP were all higher than those in control group （P<0.01）. Besides， response rate of abdominal pain and defecation and remission rate of IBS-SSS in observation group 95.38%（62/65）， 93.85%（61/65） and 90.77%（59/65）were higher than 83.33%（55/66），78.79%（52/66）and 75.76%（50/66） in control group （P<0.05）. And curative effect of traditional Chinese medicine （TCM） syndromes in was better than that in control group （Z=2.1034， P<0.05）. No serious adverse events happened and no adverse reaction caused by TCM. Conclusion:Addition and subtraction therapy of Xiaoyaosan combined with Simotang can significantly ameliorate IBS-C symptoms， reduce bad mood， improve patients' quality of life， regulate a variety of brain gut peptide factors， and improve brain gut axis disorder. It has good clinical efficacy and safety.

RutecarpineAttenuatesVascularSmoothMuscleCellCalcificationviaSirt1 / 中山大学学报(医学科学版)

@#【Objective】ThisstudyaimstoinvestigatewhetherrutecarpinehasaneffectoncalcificationofVSMCand itsunderlyingmechanism.【Methods】InvitromodelofratVSMCcalcificationwasusedinthisstudy.Rutecarpineat differentconcentrationswasusedtotreatculturedratVSMC.Theexpressionof Runx2，BMP2 and Osterix wasanalyzed byqRT-PCRandmineraldepositionwasdetectedbyalizarinredstaining.Inaddition，weexaminedtheeffectofrutecar⁃ pineonSirtuin-1（Sirt1）expressioninVSMCandtheeffectofSirt1inhibitoronVSMCcalcification.【Results】Alizarinred stainingandcalciumcontentassayshowedthatrutecarpineatdifferentconcentrationssignificantlyreducedcalcificationof ratVSMCinducedbyhighphosphorusandhighcalcium（136±10，75±6，52±6，31±5.29，P<0.05）.Usageofrutecar⁃ pinedecreasedtheactivityofALP，anosteogenicdifferentiationmolecularmarker，anddown-regulatedtheexpressionof Runx2（2.85±0.25，1.75±0.18，1.62±0.13，1.36±0.16，P <0.05），BMP2（3.2±0.32，1.85±0.17，1.65±0.15，1.43± 0.12，P<0.05）andOsterix（2.60±0.27，1.82±0.16，1.55±0.15，1.36±0.17，P<0.05），suggestingthatrutecarpineinhib⁃ ited osteogenic differentiation of VSMC. In addition，high phosphorus and high calcium down-regulated the expres⁃ sionofSirt1inVSMC.qRT-PCRandwesternblotanalysisconfirmedthatrutecarpineup-regulatedtheexpressionof Sirt1atbothmRNA（0.35±0.06，0.75±0.11；0.22±0.08，0.87±0.13，P <0.05）andproteinlevels（0.38±0.09，0.71±0.13，P<0.05）.QuantificationofcalciumcontentanalysisshowedinhibitionofSirt1byEX-527blockedtheinhibitory effectofrutecarpineonVSMCcalcification（138±13，36±7，87±8，P<0.05） .【Conclusion】Wedemonstratethatrutecar⁃ pineattenuatesVSMCcalcificationviaup-regulationofSirt1.

Application of bone-retaining femoral stem prosthesis in young patients with Dorr C femoral medullary cavity / 中国骨伤

OBJECTIVE@#To assess the clinical efficacy of Tri-Lock bio-short prosthesis in artificial total hip arthroplasty(THA) in young patients with Dorr type C femoral medullary cavity.@*METHODS@#From January 2010 to January 2014, 35 young patients(37 hips) with in the chimney-like femoral medullary cavity received Tri-Lock BPS prosthesis of THA, including 18 males(20 hips) and 17 females with an average age of (32.2±3.0) years old ranging from 21.2 to 38.5 years old. There were 16 cases of rheumatoid hip arthritis (17 hips), 8 cases of rheumatoid arthritis (9 hips), and 11 cases of aseptic necrosis of femoral head (11 hips). All cases were complicated with different degrees of osteoporosis. According to Singh index, 26 cases were classified as Grade III and 9 cases as Grade II. Biological prostheses were used for the acetabulum, with ceramic lining and full ceramic femoral head. The proximal femoral medullary cavity was Dorr type C on anteroposterior X-ray. After replacement, X-ray examination was performed to locate the prosthesis stem. Engh and Harris criteria were used to evaluate the stability of bone-prosthesis interface and hip function, respectively. Changes of hip movement pre-operation and at last follow-up were compared.@*RESULTS@#All patients were followed up for 18 to 45 months(means 33.8 months). Harris hip scores in 35 cases (37 hips) increased significantly from preoperative 61.8±3.0 (51.2 to 73.5) to 93.3±6.5 (92.5 to 98.8) points at last follow-up (=54.745, <0.01). The hip mobility increased from (46.5±8.0)°(0° to 55°) before surgery to(101.2±10.5)°(85° to 130°) at the last follow-up, the difference was statistically significant(=133.091, <0.01). Immediately after surgery, the prostheses were tightly packed with the medullary cavity. At the final follow-up, 17 hips had significant femur cortical bone thickening;12 hips had varying degrees of stress occlusal bone resorption at proximal femoral, including 9 degree I(low femur density, round and blunt) and 3 degree II(involving small rotor) hips. Meanwhile, 15 hips had significant femur cortical bone thickening without thigh pain.@*CONCLUSIONS@#The cone-shaped short Tri-lock biological short-stem can fill Dorr C chimney-like medullary cavity and effectively retain good proximal femoral bone mass. Titanium microporous coating on the surface can effectively increase the friction of the prosthesis. The short-stem end in the medullary cavity can effectively avoid the occurrence of coxa varus.

Application of Tri-Lock bone preservation stem in acetabular protrusion combined with shorten defect of femoral head and neck / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the manipulation technique and clinical outcome of Tri-Lock bone preservation stem for acetabular protrusion combined with shorten defect of femoral head and neck.</p><p><b>METHODS</b>From January 2013 to December 2015, 10 patients(12 hips) with acetabular protrusion combined with shorten defect of femoral head and neck were treated with total hip arthroplasty(THA) including 5 males and 5 female with an average age of(51.6±3.0) years old ranging from 42.5 to 67.5 years old. The acetabular prostheses were all biological prosthesis with the ceramic lining, the whole ceramic femoral head was used in all the cases. The posterior-lateral hip incision was adopted in the surgery. The follow-up was carried out in 12 months after the surgery, and later once a year. The Harris score system in growth of femoral side described was used to assess the joint function of the patients before and after the surgery.</p><p><b>RESULTS</b>Ten patients were followed up for 8 to 48 months with an average of 33.0±3.5. All the incisions healed well and there were no complications such as femoral fracture, infection, dislocation and neurovascular injuries. The biological compression of the acetabulum and the stem of the femur was realized immediately after operation in 10 patients(12 hips). X-ray at 3 months after the operation showed bone growth were extended in a wide range, which could achieve bone fixation, no loosening and re-invagination. The range of hip movement increased from (45.8±7.5)° to (90.0±6.5)° at the final follow-up, with flexion increased to (89.0±6.0)°, abduction increased to (35.5±7.3)° and internal rotation increased to(31.8±6.6)°, the outer rotation increased to(32.6±5.2)°. The mean Harris scores had improved from 45.7±7.5 pre-operatively to 93.5±8.0 post-operatively, there was statistically significant difference between before and after surgery (=144.832,<0.05).</p><p><b>CONCLUSIONS</b>Combined with acetabular treatment, Tri-Lock bone retention of the femoral stem in the treatment of femoral head and neck with shortening of the acetabular retraction and severe hip joint soft tissue contracture in patients, could be well pressed and retained more bone. The reconstruction of the acetabulum and the delamination of soft tissue are required during the operation. The results were safe and satisfactory in the middle and short term follow-up.</p>

Periprosthetic joint infection after artificial joint replacement and preoperative anemia / 中国骨伤

Periprosthetic joint infection is the most serious complication after artificial joint arthroplasty. Epidemiological investigation has indicated that perioperative anemia is an independent risk factor for periprosthetic joint infection, which could play an important role by suppressing cellular mechanisms and autoimmune functions. Many domestic and overseas scholars have studied the relationship between periprosthetic joint infection and postoperative anemia, but the relationship between preoperative anemia and periprosthetic joint infection is relatively rare. However, preoperative anemia can reduce the C3b receptor on surface of red blood cells, decrease immune function of the body, increase blood-borne infection, prolong postoperative rehabilitation time, and lead to periprosthetic joint infection. For patients with preoperative anemia, prophylactic antibiotics could be used to prevent. And complement chalybeate used before operation, correct anemia by hemopoietin, treat chronic complications influence by hemoglobin production and improve patient's own immune status, blood transfusion treatment for patients with blood transfusion indications are performed. It could be better prevent occurrence of periprosthetic joint infection after total joint arthroplasty, and reducing chance of secondary or multiple renovations.

Choice of total knee arthroplasty: posterior cruciate ligament preserved or not / 浙江大学学报·医学版

Total knee arthroplasty is an effective method for the treatment of end-stage knee osteoarthrosis, which can effectively relieve joint pain and reconstruct the integrity of the joint. Whether the posterior cruciate ligament should be preserved during surgery or not, which is still in dispute. In recent years, posterior cruciate-retaining and substituting total knee prostheses are both applied in clinical practice. Both domestic and international studies have shown that there are no significant difference in patient satisfaction, knee flexion, survival rate of the prosthesis and the main clinical manifestations between two prostheses. However, posterior cruciate-retaining total knee prosthesis is more consistent with the normal physiology and biomechanics of the human body. The gait is more balanced and proprioceptive when walking up and down the stairs, but when the joints are buckling, the femur is abnormal to move back to the tibia, resulting in abnormal motion. While posterior cruciate-substituting total knee prosthesis can correct severe deformity of the knee, and keep better balance between flexion and extension of the knee joint, but there is a potential complication of patellar clunk syndrome. Therefore, under the same conditions, the younger patients may prefer to chose posterior cruciate-retaining total knee prosthesis, while elder patients may prefer to chose posterior cruciate-substituting total knee prosthesis. This paper reviews the function of posterior cruciate ligament, as well as the advantages and disadvantages of two prostheses, so as to provide some references for clinic.

Animal models in periprosthetic osteolysis / 中国组织工程研究

BACKGROUND: There are a variety of methods for establishing periprosthetic osteolysis animal model, and the models established by different methods and with different animals have their own characteristics.OBJECTIVE: To review the research profiles of the periprosthetic osteolysis and the characteristics of the various models, and to provide a reference for the related research. METHODS: The relevant articles on the periprosthetic osteolysis animal models were searched in PubMed from January 1999 to May 2017, with the key words of "animal model, osteolysis" in English by the computer. Similarly, Chinese Journal Full-text Database was retrieved for related articles published from January 1999 to May 2017, with the key words of "animal model, osteolysis" in Chinese. Articles that were unrelated to the periprosthetic osteolysis animal model were excluded. Classic and recently published articles were selected. RESULTS AND CONCLUSION: (1) The artificial induced animal models are the principal means to establish animal models of periprosthetic osteolysis and they have been widely used in the study of periprosthetic osteolysis pathogenesis, pathological process and treatment. (2) Small-animal models present many advantages: inexpensive to purchase, high physiological turnover, controlled source, homogenous and established genetic background. However, a limitation of these small-animal models is that the temporal pattern of osteolysis is different from the long-term osteolysis that occurs in patients. (3) The large animal model is more similar to the bone dissolution process around the human prosthesis, but the cost is high; the breeding is difficult; the operation requirement is hard. Thus, its widespread use is limited. (4) Furthermore, innovative models that combine the advantages of both are also constantly explored. Overall, the selection of models should be based on research conditions and needs to be considered.

Relationship between hip tuberculosis course and total hip arthroplasty / 中国组织工程研究

BACKGROUND: Hip tuberculosis was second to that of the spine. A great number of cases were diagnosed hip tuberculosis every year. The early stage of hip tuberculosis is difficult to be diagnosed, and the X-ray images often show no abnormal signs. When there is an abnormal sign on X-ray, the extent of bone destruction is generally more than 50%. Selection of treatment methods for the patients with hip tuberculosis is the important issue in face of every clinician. OBJECTIVE: To review various types of research progress in clinical treatment of hip tuberculosis in recent years, and to provide reference for clinical treatment of hip tuberculosis. METHODS: We retrieved database of PubMed and CNKI for studies concerning clinical treatment of hip tuberculosis published from January 1969 to March 2017. Key words were "tubercular arthritis, hip, total hip replacement, treatment". After removal of repetitive or irrelevant articles, 42 articles were finally included. RESULTS AND CONCLUSION: (1) In the treatment, current emphasis was on mobility with stability at the hip. (2) Adults with advanced arthritis should be informed and discussed the various treatment modalities including the joint replacement. (3) With the development of artificial arthroplasty, total hip replacement was the preferred choice for patients with advanced hip tuberculosis. More and more surgeons were taking up the challenge of putting the total hip arthroplasty in the active stage of the disease.

Perioperative hidden blood loss in unilateral total knee arthroplasty: problems and characteristics / 中国组织工程研究

BACKGROUND: The hidden blood loss is the main reason for anemia after knee arthroplasty, which will delay wound healing, increase infection, prolong rehabilitation time, improve the cost of medicine, and seriously affect clinical outcome. OBJECTIVE: To summarize the new conceptions and methods about decreasing perioperative hidden blood loss of knee arthroplasty, and to provide help for the prevention of hidden blood loss in total knee arthroplasty. METHODS: We retrieved CNKI and PubMed for articles concerning perioperative hidden blood loss following total knee arthroplasty published from January 2005 to February 2017. We choose different controlled clinical trials about the method of preventing hidden blood loss. Key words were "knee arthroplasty, hidden blood loss, artificial joint". RESULTS AND CONCLUSION: (1) Hidden blood loss during total knee arthroplasty was associated with many factors. (2) The following factors might reduce hidden blood loss: using the tranexamic acid, reducing the duration of tourniquet, raising the operated knee in a certain extent after operation, and gauging imaging data of the affected knee exactly before operation. (3) Free fatty acids were also responsible for the hidden blood loss. (4) Computer assisted surgery could not reduce the quantity of hidden blood loss, but help patient recovery. (5) The scholars have not reach an agreement about hidden blood loss in total knee arthroplasty, so the research will go continue.

Current advances in the drug-loading preparation of poly(lactic-co-glycolic acid) microspheres / 中国组织工程研究

BACKGROUND: Existing flaws have been found in the production process of poly(lactic-co-glycolic acid) (PLGA) copolymer microspheres, which lead to residual solvent, low drug loading rate and low encapsulation efficiency of sustained-release microspheres.OBJECTIVE: To review different methods for preparing PLGA microspheres from the following aspects: basic principles, advantages/disadvantages, indications and future development. METHODS: We retrieved CNKI, PubMed and Google scholar to access the articles related to the technique process of preparing PLGA microspheres published from January 2012 to April 2017, including experiment and application research on the principles and advantages/disadvantages of the various processes. RESULTS AND CONCLUSION: To date, the main methods to prepare PLGA microspheres include single/re-emulsion solvent evaporation method, spray drying method, hydrogel template method, microfluid, coaxial electrostatic spraying, phase separation method, and supercritical fluid extraction. However, no valid evidences suggest that there is a technique that completely solves all potential problems, such as drug encapsulation and release, residual solvent and appropriate shape and size. Combination and modification of the production processes is expected to develop novel PLGA microspheres with ideal encapsulation efficiency and stable drug release.

Role of macrophage polarization in periprosthetic osteolysis: its research status and advance / 中国组织工程研究

BACKGROUND: In terms of both phenotype and function, macrophages have remarkable heterogeneity. In respond to various environmental cues or under different pathophysiologic conditions, macrophages can be polarized into different phenotypes, that is, pro-inflammatory M1 phenotypes (classical activated marcrophage) or anti-inflammatory M2 phenotypes (alternative activated marcrophage). Macrophage polarizatinton has been found to play an important role in periprosthetic osteolysis. OBJECTIVE: To summarize the research status and new progress of the concept of macrophage polarization, the relationship between osteolysis as well as treatment methods of osteolysis. METHODS: A computer-based online retrieval was performed for the literature concerning macrophage polarization and periprosthetic osteolysis in PubMed and CNKI databases published from January 1999 to March 2017. Unrelated researches on macrophage polarization were excluded. The keywords were "macrophage polarization, wear particles, and osteolysis" in English and Chinese, respectively. RESULTS AND CONCLUSION: (1) The periprosthetic osteolysis after artifical joint replacement has a close relationship with macrophage, but few studies have been carried out from the respect of macrophage polarization.Most of researches are still on in vitro observation or experimental stage. (2) Current researches mainly show that macrophages can be polarized into different phenotypes by stimulation of wear particles and cytokines, the peri-implant macrophage phenotype has M1 characteristics and some cytokines can induce macrophages polarization to M2 type with anti-inflammatory characteristics. This conclusion has a broad prospect, but the related mechanisms still remain unclear, which need a further exploration.

Effect of Olfactory Mucosal Neural Stem Cells on Neuronal Apoptosis in Rats / 中国康复理论与实践

@#Objective To investigate the effect of olfactory mucosal neural stem cells (OM-NSCs) on neuronal apoptosis in rats. Methods OM-NSCs were isolated from adult male Sprague-Dawley rats, and neurons were isolated from fetal Sprague-Dawley rats. The neurons were divided into blank group, control group and experiment group after culture in vitro, which were further cultured in nomal, cultured in nomal 24 hours after stimulation of interleukin-1β (IL-1β), and cultured with OM-NSCs 24 hours after stimulation of IL-1β, respectively, for 24 hours. The apoptosis of neurons was observed with double staining of TUNEL and microtubule-associated protein 2 antibodies. Results There were few apoptotic cells in the blank group, and very many in the control group; the apoptotic cells were fewer in the experiment group than in the control group (F=39.764, P<0.01).Conclusion OM-NSCs can significantly inhibit neuronal apoptosis, which may play a role in neuroprotection.

Advance in Metabolomics of Spinal Cord Injury (review) / 中国康复理论与实践

@#Spinal cord injury (SCI) often causes different degrees of sensory and motor dysfunction, resulting in permanent disability, with many complications and difficult to cure. Metabolomics, as a new developing technique, identifies specific biomarkers for diagnosis, treatment or prognosis judgement by analyzing the changes in the metabolites after individual stress, and can make the best treatment and rehabilitation program for the patients in the early stage of the disease. At present, some achievements have been made in the diagnosis, treatment and prognosis monitoring of spinal cord injury, and some potential biomarkers have been identified. However, the pathophysiology of spinal cord injury is not fully understood, and relevant biomarkers are also lacking in clinical trials.

Perioperative and drug management of patients with rheumatoid arthritis treated with joint replacement / 中国骨伤

Rheumatoid arthritis (RA) is a most common inflammatory joint disease with direct invasion of joint synovial membrane, cartilage and bone. Currently, although the RA mitigation drugs are being improved continously, but these drugs only can delay the development of joint dysfunction. Total hip arthroplasty or total knee arthroplasty(THA or TKA) has become the only choices for patients with advanced RA, and the joint function and deformity of the patients after surgical treatment can be improved to some extent. However, the progression of RA has a direct effect on the long-term clinical effect of the surgery, and how to improve perioperative management, and combine the joint replacement surgery and drug therapy effectively, have become the focus of attention in clinical doctors. This article intends to summarize the current situation of domestic and foreign management of usage of pre-operative drugs, operation skills, prosthesis selection, postoperative treatment, rehabilitation and complications, so as to improve the long-term efficacy of joint replacement.

Repair soft-tissue defect in forefoot with reversed lateral soleus muscle flap / 中国骨伤

<p><b>OBJECTIVE</b>To summarize clinical application results of repair soft tissue defect in forefoot with a reversed lateral soleus muscle flap on peroneal artery pedicle.</p><p><b>METHODS</b>From January 2005 to January 2013, 8 patients with soft-tissue defect on forefoot were underwent reconstruction with a reversed lateral soleus muscle flap on peroneal artery pedicle. There were 6 males and 2 female, aged from 16 to 48 years with an average of 26.8 years old. The reversed lateral soleus muscle flap was transposed to the forefoot defect area, then immediate coverage of the muscle flaps were performed by a meshed split-thickness free skin graft. The donor site was closed directly. The muscle flap survey was observed after the repair of the forefoot.</p><p><b>RESULTS</b>All muscle flaps had survived completely. No clinical vascular deficiency was found on muscle flaps postoperatively. One case occurred recipient area sustained insignificant superficial infection, one patient developed distal muscle flap small skin graft necrosis, and spontaneous heal by 2 weeks' change dressing. Follow-up period was ranged form 2.5 to 5.5 years with an average of 3.5 years postoperatively. A good contour was confirmed at the recipient area. According to Cedell questionnaire, 6 patients obtained good results and 2 fair.</p><p><b>CONCLUSIONS</b>When the local skin flap or muscle flap application is limited, lateral soleus muscle flap survey is satisfactory after repair and very suitable for repair of soft tissue defect of forefoot.</p>

Study on therapeutic effects of arthroscopic repair on medial patellar retinaculum acute injury / 中国骨伤

<p><b>OBJECTIVE</b>To accurately define the injury position of medial patellar retinaculum with acute injury under the guiding of high frequency ultrasonography, and to study therapeutic effects of suture operation on medial patellar retinaculum in the injuried position.</p><p><b>METHODS</b>From June 2009 to March 2014, there were 17 patients with acute patellar dislocation, 6 males and 11 females with average age of (16.2±6.2) years old. The duration time of patellar dislocation was 2 weeks. Before operation, the medial patellar retinaculum of all patients were examined with the high frequency ultrasonography, and the skin with the non-continuous fiber was iudicated as the surface mark under the high frequency ultrasonography. The injury position of medial retinaculum was in the middle of 5 patients who were treated with suture operation of arthroscopic medial retinaculum. The injury position was in the patellar edge in 12 patients who were treated with fixing bone anchor on patella and arthroscopic suture operation of medial retinaculum. The CT examination and Kujala scores, patellar tilt angle on CT film, measured maximal angles of passive or active knee flexion and apprehension test were observed before treatment and postoperative 18 months.</p><p><b>RESULTS</b>Eighteen months after treatment, Kujala scores were 92.2±11.1 and patellar tilt angle were(11.5±4.2) °, and there was no statistical difference between post-operation and pre-operation. The difference between maximal angles of passive knee flexion(133.5±4.2) ° and normal had no statistically significance. Maximal angles of active knee flexion were(153.5±4.6) °. Ultrasonography showed the continuous fiber of medial retinaculum. A patient showed positive apprehension test and no patient had the recurrence patella instability after operation.</p><p><b>CONCLUSIONS</b>The injury position of medial patellar retinaculum was accurately shown by high frequency ultrasonography and treated with arthroscopic suture operation. Knee immobilization time after operation was shorten. Eighteen months after operation, knee joint function was good, and no patient had the recurrence patella instability.</p>