Chondrogenic properties of primary human chondrocytes culture in hyaluronic acid treated gelatin scaffold.

OBJECTIVE: To study the possibility of primary human chondrocytes culture in gelatin scaffold and the effects of exogenous HA on chondrocyte differentiation and synthesis of the hyaline-like extracellular matrix. MATERIAL AND METHOD: Cartilage tissue was engineered by using primary human chondrocytes with HA-treated gelatin scaffolds and gelatin scaffolds. The chondrogenic properties were monitored for chondrocyte proliferation, adhesion, and hyaline-like extracellular matrix production in both groups. The results were compared to each other. RESULTS: Chondrocyte proliferation, adhesive activity, and new HA production were significantly increased in HA-treated gelatin scaffold (p < 0.05). Immuno histochemistry for WF6 epitope demonstrated the higher quality of hyaline-like extracellular matrix production. Moreover, the scanning electron micrograph showed a higher filling of extracellular matrix in the pore of scaffold of HA-treated gelatin scaffold than that in non-HA treated scaffold. CONCLUSION: The present study demonstrated the possible role of commercial gelatin-based scaffold in cartilage tissue engineering. It also demonstrated that exogenous HA-treated scaffold provides positive effects for chondrocytes.

Diagnosis and treatment of osteoporosis following hip fracture in Chiang Mai University Hospital.

BACKGROUND: Osteoporosis is defined as a skeletal disorder characterized by compromised bone strength predisposing a person to an increased risk of fracture. Hip fracture is the common and serious consequence of osteoporosis. To improve bone quality and prevent new fracture, osteoporosis should be treated while the patient was admitted with hip fracture problem. Several medications have been proven to be effective. Objectives of the present study were to determine the adequacy of diagnosis and treatment of osteoporosis in hip fracture patients. MATERIAL AND METHOD: A retrospective study of all low energy trauma hip fracture patients, between 1998 and 2003 at the age of 50 years old or more. The National Osteoporosis Foundation guideline was used to identify adequacy of diagnosis and treatment of osteoporosis in this group of patients. Age, sex, admitted diagnosis, mechanism of injury, admission medication, treatment procedures, discharge medication, BMD investigation were analysed. RESULTS: The percentage of calcium supplementation for the discharged patients in 1998 to 2003 was 0%, 10.5%, 33.3%, 32.7%, 39.3% and 43.0% respectively. The percentage of combination of calcium and vitamin D supplementation for the discharged patients was 0%, 8.8%, 21.1%, 12.7%, 24.6% and 37.5% respectively. Bisphosphonate was ordered in 9 and calcitonin in 20 patients. 7% of patients were diagnosied as osteoporosis. The quantity of osteoporosis was confirmed by DXA measurement in only one patient. CONCLUSIONS: In the past 6 years, most of the hip fracture patients were underdiagnosed and undertreated for osteoporosis. There was also a good trend for better treatment.

Factors influencing the treatment of posterior cruciate ligament injury.

The primary objective was to determine the factors which influence the requirement of surgical treatment of posterior cruciate ligament (PCL) injury. Ninety one PCL injured patients diagnosed in the "Sports Medicine Clinic", Maharaj Nakorn Chiang Mai Hospital from January 1998 to December 2000 were included in the present study. There were 63 males and 28 females with an average age of 29 years. All of the PCL-insufficient knees were initially treated by non-operative method including 3 phases of rehabilitation. They were followed through to the end of December 2003. Analysis showed that the degree of posterior laxity was the only factor that had a statistical significant correlation to failure of conservative treatment. In addition, the need for surgical treatment was not associated with gender age, cause of injury, and concomitant of injury. The authors concluded that PCL injured patients with posterior laxity greater than 10 millimeters should be treated by PCL reconstruction.

Epidemiology of hip fracture in Chiang Mai.

The incidence of hip fracture varies worldwide. From 1997 to 1998, the incidence of hip fracture in Chiang Mai was 151.2 and 185.2 per 100,000 from the hospital survey and the community survey respectively. The mortality rate in hospital following hip fracture was 2.1% and the one-year mortality rate rose steadily to 37%. In addition, morbidity after hip fracture may also carry serious implications on the functional independence and quality of life. Concerning the costs for treatment, hip fracture is also a great burden for the health service in Thailand. The risk factors for hip fracture include age, medical co-morbidities, current use of antihistamine, history of fracture, alcoholic consumption, low calcium intake and lack of physical activity, whereas calcium intake and physical activity were demonstrated as important protective factors against hip fracture. Improved understanding for epidemiology of hip fracture in Thailand could enhance the effectiveness for prevention of the fracture.