Comparing the efficacy of core decompression with autologous bone marrow mononuclear cell grafting with impacted bone grafting in treating bilateral femoral head necrosis / 中华骨科杂志

Objective@#To compare the efficacy of core decompression with autologous bone marrow mononuclear cell grafting with impacted bone grafting in treating bilateral femoral head necrosis.@*Methods@#From January 2011 to January 2017, a total of 44 patients with bilateral femoral head necrosis (88 hips) were admitted to the Department of Orthopaedics, China-Japan Friendship Hospital, including 35 males and 9 females with aged 34.9±7.2 years old (ranged from 22-48 years). Core decompression with autologous bone marrow mononuclear cell and impacted bone grafting were conducted to each hip joint for every patient. All patients were followed up for every 3 months at the first year postoperatively and for every 6 months thereafter. The following clinical measurement were recorded, Harris hip score (HHS), visual analogue score (VAS), the anterior-posterior and frog lateral radiographs, and CT. The 5-year survival rate of the hip was calculated with the endpoint event being defined as a need for total hip arthroplasty or other surgical intervention, or a HHS less than 70.@*Results@#The postoperative follow-up duration was 50.5±34.2 months in the impacted bone grafting group and 54.0±33.1 months in the core decompression with autologous bone marrow mononuclear cells group. Fifteen hips in the impacted bone grafting group and 13 hips in the core decompression with autologous bone marrow mononuclear cell group failed during the follow-up. The 5-year cumulative survival rates of the hips in two groups were 64.7% and 72.1%, respectively [HR=1.178, 95%CI(0.561, 2.477)]. In the impacted bone grafting group, the 5-year survival rates of the hip joints at the ARCO IIIB+IIIC and IIIA stages were 42.9% and 74.2%, respectively [HR=3.258, 95%CI(1.172, 9.059)]. In the core decompression with autologous bone marrow mononuclear cell group, the 5-year survival rates of hips at the ARCO stage I, II and IIIA stages were 50.0%, 75.3%, and 71.4%, respectively (χ2=0.757, P=0.685). Age, gender, BMI, preoperative HHS and etiology did not affect the effects of core decompression with autologous bone marrow mononuclear cell grafting or impacted bone grafting (P>0.05). The preoperative VAS of the impacted bone grafting group and the core decompression with autologous bone marrow mononuclear cell grafting group were 4.80±0.62 and 3.27±1.17, respectively (t=8.625, P<0.001). At the last follow-up, the VAS was reduced to 2.84±1.95 and 2.25±2.08, respectively (t=2.712, P=0.01; t=7.087, P<0.001) with significant difference in postoperative VAS between the two groups (t=2.489, P=0.017). The preoperative HHS of the impacted bone grafting group and the core decompression with autologous bone marrow mononuclear cell grafting group were 77.02±5.03 and 82.57±5.71, respectively (t=7.822, P<0.001). At the last follow-up, the HHS increased to 81.57±12.81 and 83.55±12.87, respectively. The difference between the preoperative and postoperative HHS was statistically significant in the impacted bone grafting group (t=2.389, P=0.021) but not in the core decompression with autologous bone marrow mononuclear cell grafting group (t=0.451, P=0.654). There was no significant difference in postoperative HHS between the two groups (t=1.353, P=0.183).@*Conclusion@#Both impacted bone grafting and core decompression with autologous bone marrow mononuclear cell grafting are safe and effective methods in treating femoral head necrosis. The ARCO stage is a risk factor affecting the prognosis of hips after impacted bone grafting, which has no effect on the mid-term survival of hips after core decompression with autologous bone marrow mononuclear cell grafting.

A Case of Late Renal Transplant Segmental Infarction / 대한신장학회잡지

Acute thrombosis of the renal transplant artery is a well-known vascular complication of renal allograft that usually occurs within the first month post-transplant and often leads graft loss. The incidence of this complication varies between 0.8 and 3.5%. Beyond this period of time, this complication is distinctly uncommon except in rejected kidneys or in a kidney with high grade arterial stenosis. Here we are reporting a case of late renal transplant segmental infarction in 55 years old male patient who presented with sudden allograft pain, fever, and graft dysfunction 15 months after renal transplantation. Graft function improved slightly and became stable with the anticoagulation therapy.

Effect of Repeated Graft of Fetal Mesencephalic Cells in 6-Hydroxydopamine Rat Model of Hemiparkinsonism

OBJECTIVE: In this experimental study, authors evaluated the effect of repeated graft of the fetal midbrain cells on rat model of hemiparkinsonism. MATERIALS AND METHODS: Following injection of the 6-hydroxydopamine into striatum, we examined the behavior (turning response to amphetamine and apomorphine) at 2, 4 and 8 weeks. Their turning behavior persisted until 8 weeks after lesion making. Only those with turning behavior of more than average 6.2turns/minute by amphetamine test were selected for transplantation. Three different methods of transplantation were assigned into three groups and compared with each other to evaluate their efficiencies in improving behavioral responses. In first method, the volume of the transplanted cells were equivalent to that of one fetal midbrain. The volume of the transplanted cells were twice as much as that of one fetal midbrain in a group with second method. The last group consisted of repeated transplantation. Here, we transplanted the same amount of fetal midbrain cells as the in group 2 with two divided doses in one month interval. RESULTS: The second and third group improved from amphetamine test significantly(p<0.05), whereas first group failed to show any significant improvement from same test. The results from second and third group were not significantly different from each other. CONCLUSION: This results suggest that transplantation of two volumes of the fetal midbrain is needed to improve the turning behavior of this model of parkinsonism. This volume can be tansplanted at once or it may be transplanted in two divided volumes with time interval, with similar effect.

Dynamic changes of rat donor mycardial cell apoptosis during hypothermic preserv ation and the protective effect of melatonin / 中华器官移植杂志

ObjectiveTo study the dynamic changes of rat donor myocardial cell apoptosis during hypot hermic preservation and the effect of melatonin.MethodsEighty rats were randomly divided into two groups: experimental group with the i solated rat hearts being preserved in 4?℃ St Thomas solution with melatonin ( 0.1?mmol/L ); control group with the isolated rat hearts being preserved in 4?℃ St Thomas solution only. After preservation for 4, 8, 12, 24 and 36?h, a poptotic index was evaluated by the percentage of mycardial cells using TUNEL po sitive staining.ResultsWith the hypothermic preservation time prolonging, more myocardial cell apoptosi s was found (control group, P