Treatment preferences and current practices regarding open tibial shaft fractures.

Purpose: The purpose of this study was to reveal the treatment preferences and current practices regarding open tibial shaft fracture (OTSF). Patients and methods: Online surveys of treatment preferences and current practice of OTSF were conducted by orthopedic trauma doctors from various medical institutions in Zhejiang Province. The survey contains three modules. The first module is the basic information of the participants, the second module is the treatment patterns for Gustilo-Anderson type I-II (GA I/II), and the third module is the treatment patterns for Gustilo-Anderson type IIIA (GA IIIA). Furthermore, each treatment pattern was divided into four aspects, including antibiotic prophylaxis, irrigation and debridement, fracture stabilization, and wound management. Results: A total of 132 orthopedic trauma doctors from 41 hospitals in Zhejiang province, participated the online surveys. In GA I-IIIA OTSF, more than three-quarters of participants considered <3 h as the appropriate timing of antibiotic administration after trauma. In fact, only 41.67% of participants administered antibiotics within 3 h after trauma. 90.91 and 86.36% of participants thought debridement within 6 h was reasonable for GA I/II and GA IIIA OTSF, respectively. However, in reality only about half of patients received debridement within 6 h on average. The most common reason for delayed debridement was patients' transport delay. 87.88 and 97.3% of participants preferred secondary internal fixation following external fixation for GA I/II and GA IIIA OTSF, respectively. Additionally, over half of participants preferred use of locking plate for treating GA I-IIIA OTSF. The most common reasons for choosing delayed internal fixation for GA I-IIIA OTSF were infection risk and damage control. 78.79 and 65.91% supported immediate internal fixation after removing the external fixation for GA I-IIIA OTSF, respectively. Regarding wound closure, 86.36 and 63.64% of participants reported primary closure for GA I/II and GA IIIA OTSF, respectively. Over three fourths of participants agreed that preoperative and postoperative multiple wound cultures should be performed to predict infection for GA I-IIIA OTSF. Conclusion: The study first presents the current preference and practice regarding management of GA I-IIIA OTSF in Zhejiang. Majority of surgeons in our study preferred secondary internal fixation following external fixation for GA I-IIIA OTSF and over half of surgeons preferred use of locking plate for treating GA I-IIIA OTSF. This study may provide a reference for trauma orthopedic surgeons in the treatment of GA I-IIIA OTSF.

Predicting survival of patients with bone metastasis of unknown origin.

Purpose: Bone metastasis of unknown origin is a rare and challenging situation, which is infrequently reported. Therefore, the current study was performed to analyze the clinicopathologic features and risk factors of survival among patients with bone metastasis of unknown origin. Patients and methods: We retrospectively analyzed the clinical data for patients with bone metastasis of unknown origin between 2010 and 2016 based on the Surveillance, Epidemiology, and End Results (SEER) database. Overall survival (OS) and cancer-specific survival (CSS) were first analyzed by applying univariable Cox regression analysis. Then, we performed multivariable analysis to confirm independent survival predictors. Results: In total, we identified 1224 patients with bone metastasis of unknown origin for survival analysis, of which 704 males (57.5%) and 520 females (42.5%). Patients with bone metastasis of unknown origin had a 1-year OS rate of 14.50% and CSS rate of 15.90%, respectively. Race, brain metastasis, liver metastasis, radiotherapy, and chemotherapy were significant risk factors of OS on both univariable and multivariable analyses (p <0.05). As for CSS, both univariable and multivariable analyses revealed that no brain metastasis, no liver metastasis, radiotherapy, and chemotherapy were associated with increased survival (p <0.05). Conclusion: Patients with bone metastasis of unknown origin experienced an extremely poor prognosis. Radiotherapy and chemotherapy were beneficial for prolonging the survival of those patients.

The cervical sagittal curvature change in patients with or without PCSM after laminoplasty.

Objective: After laminoplasty, the cervical sagittal curvature of some patients tend to be lordotic, this phenomenon cannot be explained by the theory of laminoplasty, and the reason remains unknown. We explored the possible role played by pinching cervical spondylotic myelopathy (PCSM) in the cervical sagittal curvature change in patients after laminoplasty. Methods: From April 2017 to May 2019, we studied 122 patients undergoing laminoplasty with cervical spondylotic myelopathy (CSM). All patients were divided into Group A (anterior compression only, without PCSM) and Group B (both anterior and posterior compression, with PCSM). The visual analogue scale (VAS) was used to measure pain, and modified Japanese Orthopedic Association (mJOA) score was derived. The cervical global angle (CGA) and the range of cervical motion (ROM) were compared. The clinical and imaging results were compared between Group A and Group B. Results: After laminoplasty, both the mean VAS and mJOA scores improved significantly in Group A and Group B, the mJOA recovery rate of Group B was better than that of Group A (P < 0.05). The mean CGA and ROM decreased in Group A, but increased in Group B. MRI revealed that the ligamentum flavum of Group A was significantly thinner than that of Group B (P < 0.05). Conclusions: Because of the hypertrophic and folded ligamentum flavum compressing the dorsal spinal cord, patients with PCSM may maintain a compulsive kyphotic posture. After laminoplasty, the cervical sagittal curvature of these patients tend to be lordotic due to the release of dorsal spinal cord compression.

Survival Analysis in Gastrointestinal Neuroendocrine Carcinoma With Bone Metastasis at Diagnosis.

PURPOSE: Gastrointestinal neuroendocrine carcinoma (NEC) with bone metastasis is rarely reported. The purpose of this study is to explore the prognosis and risk factors of such patients. PATIENTS AND METHODS: We retrospectively reviewed patients diagnosed as gastrointestinal NECs with bone metastasis at diagnosis from 2010 to 2016 by using the Surveillance, Epidemiology and End Results (SEER) database. Predictors of overall survival (OS) and cancer-specific survival (CSS) were analyzed by univariable and multivariable Cox analyses. Kaplan-Meier plots were constructed to show the correlation between independent predictors and survival. RESULTS: A total of 330 gastrointestinal NEC patients with bone metastasis at diagnosis were included for analysis. Over half of patients were male and older than 60 years old. The most common primary site of gastrointestinal NEC with bone metastasis was the pancreas. The prognosis of gastrointestinal NEC with bone metastasis (3-year OS and CSS rates: 16.7 and 17.0%) was very poor. On Cox multivariable analysis, age over 60 years old, no surgery, and lung metastasis were independent predictors of decreased OS and CSS. CONCLUSIONS: We identified three independent factors associated with prognosis among gastrointestinal NEC patients with bone metastasis, namely age, surgery, and lung metastasis. For younger gastrointestinal NEC patients with bone metastasis, surgical resection of primary tumors as well as actively treating lung metastasis might be useful for prolonging survival.

Early-Stage Primary Anti-inflammatory Therapy Enhances the Regenerative Efficacy of Platelet-Rich Plasma in a Rabbit Achilles Tendinopathy Model.

BACKGROUND: Tendinopathy is a pervasive clinical problem that afflicts both athletes and the general public. Although the inflammatory changes in tendinopathy are well characterized, how the therapeutic effects of platelet-rich plasma (PRP) on tendinopathy are being modulated by the inflammatory environment is not well defined. PURPOSE/HYPOTHESIS: In this study, we aimed to compare the therapeutic effects of PRP alone versus a combination of PRP with a primary glucocorticoid (GC) injection at the early stage of tendinopathy. We hypothesized that PRP treatment could promote better tendon regeneration through the suppression of inflammation with GC. STUDY DESIGN: Controlled laboratory study. METHODS: The gene expression profile of tendon stem/progenitor cells (TSPCs) cultured with PRP was analyzed with RNA sequencing. To evaluate the cell viability, senescence, and apoptosis of TSPCs under different conditions, TSPCs were treated with 0.1 mg/mL triamcinolone acetonide (TA) and/or 10% PRP in an IL1B-induced inflammatory environment. To further verify the effects of the sequential therapy of GCs and PRP, an early tendinopathy animal model was established through a local injection of collagenase in the rabbit Achilles tendon. The tendinopathy model was then treated with isopycnic normal saline (NS group), TA (TA group), PRP (PRP group), or TA and PRP successively (TA+PRP group). At 8 weeks after treatment, the tendons were assessed with magnetic resonance imaging (MRI), histological examination, transmission electron microscopy (TEM), and mechanical testing. RESULTS: Gene Ontology enrichment analysis indicated that PRP treatment of TPSCs induced an inflammatory response, regulated cell migration, and remodeled the extracellular matrix. Compared with the sole use of PRP, successive treatment with TA followed by PRP yielded similar results in cell viability and senescence but less cell apoptosis in vitro. In vivo experiments demonstrated that the TA+PRP group achieved significantly better tendon regeneration, as confirmed by MRI, histological examination, TEM, and mechanical testing. CONCLUSION: This study showed that the primary use of GCs did not exert any obvious deleterious side effects on the treated tendon but instead enhanced the regenerative effects of PRP in early inflammatory tendinopathy. CLINICAL RELEVANCE: The sequential therapy of GCs followed by PRP provides a promising treatment strategy for tendinopathy in clinical practice. PRP combined with the primary use of GCs appears to promote tendon regeneration in early inflammatory tendinopathy.

The preconditioning of lithium promotes mesenchymal stem cell-based therapy for the degenerated intervertebral disc via upregulating cellular ROS.

Adipose-derived stem cell (ADSC) is one of the most widely used candidate cell for intervertebral disc (IVD) degeneration-related disease. However, the poor survival and low differentiation efficacy in stressed host microenvironment limit the therapeutic effects of ADSC-based therapy. The preconditioning has been found effective to boost the proliferation and the functioning of stem cells in varying pathological condition. Lithium is a common anti-depression drug and has been proved effective to enhance stem cell functioning. In this study, the effects of preconditioning using LiCl on the cellular behavior of ADSC was investigated, and specially in a degenerative IVD-like condition. METHOD: The cellular toxicity on rat ADSC was assessed by detecting lactate dehydrogenase (LDH) production after treatment with a varying concentration of lithium chloride (LiCl). The proliferative capacity of ADSC was determined by detecting Ki67 expression and the relative cell number of ADSC. Then, the preconditioned ADSC was challenged by a degenerative IVD-like condition. And the cell viability as well as the nucleus pulpous (NP) cell differentiation efficacy of preconditioned ADSC was evaluated by detecting the major marker expression and extracellular matrix (ECM) deposit. The therapeutic effects of preconditioned ADSC were evaluated using an IVD degeneration rat model, and the NP morphology and ECM content were assessed. RESULTS: A concentration range of 1-10 mmol/L of LiCl was applied in the following study, since a higher concentration of LiCl causes a major cell death (about 40%). The relative cell number was similar between preconditioned groups and the control group after preconditioning. The Ki67 expression was elevated after preconditioning. Consistently, the preconditioned ADSC showed stronger proliferation capacity. Besides, the preconditioned groups exhibit higher expression of NP markers than the control group after NP cell induction. Moreover, the preconditioning of LiCl reduced the cell death and promoted ECM deposits, when challenged with a degenerative IVD-like culture. Mechanically, the preconditioning of LiCl induced an increased cellular reactive oxidative species (ROS) level and activation of ERK1/2, which was found closely related to the enhanced cell survival and ECM deposits after preconditioning. The treatment with preconditioned ADSC showed better therapeutic effects than control ADSC transplantation, with better NP preservation and ECM deposits. CONCLUSION: These results suggest that the preconditioning with a medium level of LiCl boosts the cell proliferation and differentiation efficacy under a normal or hostile culture condition via the activation of cellular ROS/ERK axis. It is a promising pre-treatment of ADSC to promote the cell functioning and the following regenerative capacity, with superior therapeutic effects than untreated ADSC transplantation.

Osteoblastoma-Like Osteosarcoma of the Cuboid and Skull: A Case Report and Review of the Literature.

Osteoblastoma-like osteosarcoma is a rare form of osteosarcoma that shares similar clinical and pathological characteristics with osteoblastoma. We describe a 12-year-old boy with osteoblastoma-like osteosarcoma of the cuboid and skull without lung involvement. Despite inadequate primary surgical treatment, the patient recovered well after wide excision and postoperative chemotherapy. We report the case for the rarity of the sites and the misleading clinical and pathological manifestation.

Clinical features and prognostic analysis of patients with chest wall chondrosarcoma.

Chest wall chondrosarcoma is a rare malignant tumor of the bone. This study is aimed to identify the prognostic determinants of chest wall chondrosarcoma. We used the Surveillance, Epidemiology, and End Results (SEER) database to identify patients with chest wall chondrosarcoma from 1973 to 2015. Statistical analyses were performed using Kaplan-Meier method and Cox regression proportional hazards. A total of 779 patients were identified from the SEER database. The overall survival (OS) and cancer-specific survival (CSS) rates of the entire group at 10 years were 66.2% and 77.2%, respectively. On multivariate Cox regression, age ≤40 years, localized tumor stage, low tumor grade, surgery, and no radiotherapy were significantly associated with improved both OS and CSS. This study may help clinicians to predict survival of patients with chest wall chondrosarcoma and to provide appropriate treatment recommendations.

Surgery plus chemotherapy improves survival of patients with extremity soft tissue leiomyosarcoma and metastasis at presentation.

Purpose: Extremity soft tissue leiomyosarcoma (LMS) with metastasis is a rare disease with a poor prognosis. The purpose of our study was to define clinical features of extremity soft tissue LMS with metastasis as well as to identify multivariable predictors of survival. Methods: During 1973-2015, 239 patients with metastatic extremity soft tissue LMS were identified from the Surveillance, Epidemiology, and End Results (SEER) program database. The prognostic analysis was performed using the Kaplan-Meier method and a Cox proportional hazards regression model. Results: This group comprised 126 females (52.7%) and 113 males (47.3%), whose ages ranged from 8 to 95 years (median 67 years). The overall survival (OS) and cancer-specific survival (CSS) rates of the entire group at 3 years were 22.6% and 23.4%, respectively. The median OS and CSS were 14.0±1.5 and 15.0±2.3 months, respectively. Multivariate analysis revealed that tumor size >10 cm, no surgery and no chemotherapy were independent risk factors of decreased OS and CSS. Radiotherapy was not significantly associated with OS or CSS. Conclusion: Extremity soft tissue LMS patients who present with metastasis at diagnosis had a poor prognosis. Patients who performed surgery for primary tumors and chemotherapy had a better chance for prolonged survival.

Prognostic factors of patients with extremity myxoid liposarcomas after surgery.

BACKGROUND: Extremity myxoid liposarcoma (MLS) is a rare soft tissue sarcoma in adults. We performed this study to define distinctive clinical features of extremity MLS by assessing prognostic factors. METHODS: Between 1973 and 2015, 1756 patients with extremity MLS who underwent surgical resection were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database of the US National Cancer Institute. Both overall survival (OS) and cancer-specific survival (CSS) were assessed using the Kaplan-Meier method (to obtain OS and CSS curves) and a Cox proportional hazards regression model. RESULTS: Of the 1756 patients with extremity MLS, the mean and median patient age at diagnosis were 47 and 45 years, respectively. More than half (n = 1027, 58.5%) of the patients were male. In terms of location, 10.5% tumors were located in the upper limbs and 89.5% in lower limbs. All patients received local surgery, and about half of the patients (57.2%) received radiation treatment. The 5- and 10-year OS rates of the entire cohort were 86.4% and 75.9%, respectively. The 5- and 10-year CSS rates were 90.5% and 85.2%, respectively. On multivariate analysis, older age, male gender, high tumor grade, and tumor size > 10 cm were found to be independent risk factors of both decreased OS and CSS. Year of diagnosis ≥ year 2000 was significantly associated with an increased CSS. In addition, radiation treatment failed to become an independent risk factor for either OS or CSS. CONCLUSION: We identified age, gender, tumor grade, year of diagnosis, and tumor size as independent prognostic factors for OS and CSS in patients with extremity MLS.

A Collagen and Silk Scaffold for Improved Healing of the Tendon and Bone Interface in a Rabbit Model.

BACKGROUND The study aimed to develop a novel orthopedic surgical scaffold made of collagen and silk to repair the tendon and bone interface, and to investigate its influence on tendon and bone healing in a rabbit model. MATERIAL AND METHODS Four types of surgical scaffold were prepared, including a random collagen scaffold (RCS), an aligned collagen scaffold (ACS), a random collagen scaffold combined with knitted silk (RCSS), and an aligned collagen scaffold combined with knitted silk (ACSS). Rabbit bone marrow stem cells (BMSCs) were cultured and seeded onto the RCS and ACS scaffold. The animal model included four-month-old female New Zealand White rabbits (N=20) that underwent drilling into the rotator cuff of the left supraspinatus muscle tendon, randomized into the ACSS and RCSS groups. RESULTS Rabbit BMSCs adhered to and proliferated on the RCS and ACS in vitro. Transcription levels of the COL I, COL III, and tenascin (TCN) genes were significantly increased in the ACS group compared with the RCS group. Transcription levels of COL I, runt-related transcription factor-2 (RUNX-2) and bone morphogenetic protein-2 (BMP-2) were significantly increased in the RCS group compared with the ACS group. RCSS and ACSS implanted in the rabbit models for eight weeks resulted in more regenerative tissue in the RCSS group compared with the ACSS group, with new cartilage at the tendon and bone interface at 12 weeks. CONCLUSIONS A collagen and silk scaffold improved healing of the tendon and bone interface in a rabbit model.

Knitted Silk-Collagen Scaffold Incorporated with Ligament Stem/Progenitor Cells Sheet for Anterior Cruciate Ligament Reconstruction and Osteoarthritis Prevention.

Current surgical management of anterior cruciate ligament (ACL) rupture still remains an intractable challenge in ACL regeneration due to the weak self-healing capability of ACL. Inadequate cell numbers and vascularization within the articular cavity contribute mainly to the poor prognosis. This time, we fabricated a new tissue engineering scaffold by adding ligament stem/progenitor cell (LSPC) sheets to our previous knitted silk-collagen sponge scaffold, which overcame these limitations by providing sufficient numbers of seed cells and a natural extracellular matrix to facilitate regeneration. LSPCs display excellent proliferation and multilineage differentiation capacity. Upon ectopic implantation, the knitted silk-collagen sponge scaffold incorporated with an LSPC sheet exhibited less immune cells but more fibroblast-like cells, deposited ECM and neovascularization, and better tissue ingrowth. In a rabbit model, we excised the ACL and performed a reconstructive surgery with our scaffold. Increased expression of ligament-specific genes and better collagen fibril formation could be observed after orthotopic transplantation. After 6 months, the LSPC sheet group showed better results on ligament regeneration and ligament-bone healing. Furthermore, no obvious cartilage and meniscus degeneration were observed at 6 months postoperation. In conclusion, these results indicated that the new tissue engineering scaffold can promote ACL regeneration and slow down the progression of osteoarthritis, thus suggesting its high clinical potential as an ideal graft in ACL reconstruction.

Efficacy of Laminoplasty in Patients with Cervical Kyphosis.

BACKGROUND The efficacy of laminoplasty in patients with cervical kyphosis is controversial. The purpose of this study was to investigate the impact of the initial pathogenesis on the clinical outcomes of laminoplasty in patients with cervical kyphosis. MATERIAL AND METHODS A total of 137 patients with cervical spondylotic myelopathy (CSM) or ossification of the posterior longitudinal ligament (OPLL) underwent laminoplasty from April 2013 to May 2015. The patients were divided into the following 4 groups: lordosis with CSM (LC), kyphosis with CSM (KC), lordosis with OPLL (LO), and kyphosis with OPLL (KO). The clinical outcome measures included the visual analogue scale (VAS) and modified Japanese Orthopedic Association (mJOA) scores, the range of motion (ROM), and the cervical global angle (CGA). RESULTS The mean VAS and mJOA scores improved significantly in all groups after surgery. The changes in VAS and mJOA scores were significantly smaller, and the JOA recovery rate was significantly lower, in the KC group than in the LC and KO groups. The mean change in the CGA was greatest in the KC group (>8° towards kyphosis). The preoperative ROM was negatively correlated with the change in CGA and the JOA recovery rate in the KO and KC groups. CONCLUSIONS We found that laminoplasty is suitable for patients with cervical lordosis and those with mild cervical kyphosis and OPLL, but is not recommended for patients with kyphosis and CSM, particularly those with a large ROM preoperatively.

Ectopic tissue engineered ligament with silk collagen scaffold for ACL regeneration: A preliminary study.

Anterior cruciate ligament (ACL) reconstruction remains a formidable clinical challenge because of the lack of vascularization and adequate cell numbers in the joint cavity. In this study, we developed a novel strategy to mimic the early stage of repair in vivo, which recapitulated extra-articular inflammatory response to facilitate the early ingrowth of blood vessels and cells. A vascularized ectopic tissue engineered ligament (ETEL) with silk collagen scaffold was developed and then transferred to reconstruct the ACL in rabbits without interruption of perfusion. At 2weeks after ACL reconstruction, more well-perfused cells and vessels were found in the regenerated ACL with ETEL, which decreased dramatically at the 4 and 12week time points with collagen deposition and maturation. ACL treated with ETEL exhibited more mature ligament structure and enhanced ligament-bone healing post-reconstructive surgery at 4 and 12weeks, as compared with the control group. In addition, the ETEL group was demonstrated to have higher modulus and stiffness than the control group significantly at 12weeks post-reconstructive surgery. In conclusion, our results demonstrated that the ETEL can provide sufficient vascularity and cellularity during the early stages of healing, and subsequently promote ACL regeneration and ligament-bone healing, suggesting its clinic use as a promising therapeutic modality. STATEMENT OF SIGNIFICANCE: Early inflammatory cell infiltration, tissue and vessels ingrowth were significantly higher in the extra-articular implanted scaffolds than theses in the joint cavity. By mimicking the early stages of wound repair, which provided extra-articular inflammatory stimulation to facilitate the early ingrowth of blood vessels and cells, a vascularized ectopic tissue engineered ligament (ETEL) with silk collagen scaffold was constructed by subcutaneous implantation for 2weeks. The fully vascularized TE ligament was then transferred to rebuild ACL without blood perfusion interruption, and was demonstrated to exhibit improved ACL regeneration, bone tunnel healing and mechanical properties.

Missed diagnosis of oesophageal perforation in ankylosing spondylitis cervical fracture: Two case reports and literature review.

Oesophageal perforation after blunt injury cervical fracture in patients with ankylosing spondylitis (AS) is rarely reported. The early diagnosis of oesophageal perforation is extremely important. We present two cases of patients with AS who sustained cervical fracture dislocation and spinal cord injury. The ossified sharp fragments caused oesophageal perforation, and the delayed diagnoses had serious consequences. Oesophageal perforation should be suspected in patients with AS and cervical fracture if bone fragments are pressing against the oesophagus and a gas shadow is visible around the fracture site on computed tomography imaging.

Expansive Open-Door Cervical Laminoplasty: In Situ Reconstruction of Extensor Muscle Insertion on the C2 Spinous Process Combined With Titanium Miniplates Internal Fixation.

Retrospective cohort study. To evaluate efficacy and relevant problems of in situ reconstruction of extensor muscle insertion on the C2 spinous process combined with titanium miniplates internal fixation in expansive open-door cervical laminoplasty in order to improve surgical treatment effect. Expansive open-door cervical laminoplasty has been widely applied in clinical practice, but there are a series of postoperative problems. Therefore, decreasing postoperative complications in order to more effectively relieve symptoms remains a subject for additional research. From October 2011 to September 2013, a total of 60 patients who suffered cervical canal stenosis were treated by expansive open-door laminoplasty with in situ reconstruction of extensor muscle insertion on the C2 spinous process combined with titanium miniplates internal fixation. Changes of cervical curvature index (CI) and range of motion (ROM) were calculated using data from preoperative and postoperative cervical spine X-ray examinations. Clinical function was scored using the Japanese Orthopedics Association Scoring System (JOA) and the neck disability index (NDI). The mean CI before the operation and at 1-year postoperation were 10.49% ±â€Š3.93% and 14.14 ±â€Š2.85 (P < 0.05). The mean ROM values were 43.35 ±â€Š7.55 before the operation, 34.83 ±â€Š7.41 at 1-year postoperation (P < 0.05). The NDI scores decreased from 19.42 ±â€Š4.12 to 7.37 ±â€Š2.58, and the JOA scores increased from 8.87 ±â€Š1.99 to 13.55 ±â€Š1.72, representing significant improvement (P < 0.05). One patient had postoperative C5 nerve root palsy and completely recovered 1 month later. Neither collapse nor door closure in the open-door side occurred in any of the patients. Expansive open-door cervical laminoplasty with in situ reconstruction of extensor muscle insertion on the C2 spinous process combined with titanium miniplates internal fixation is a safe and effective surgical method, and can effectively decrease postoperative complications and achieve satisfactory clinical results.

Research progress in the mechanism of effect of PRP in bone deficiency healing.

Platelet-rich plasma (PRP) therapy is a recently developed technique that uses a concentrated portion of autologous blood to try to improve and accelerate the healing of various tissues. There is a considerable interest in using these PRP products for the treatment used in bone deficiency healing. Because PRP products are safe and easy to prepare and administer, there has been increased attention toward using PRP in numerous clinical settings. The benefits of PRP therapy appear to be promising, and many investigators are exploring the ways in which this therapy can be used in the clinical setting. At present, the molecular mechanisms of bone defect repair studies have focused on three aspects of the inflammatory cytokines, growth factors and angiogenic factors. The role of PRP works mainly through these three aspects of bone repair. The purpose of this paper is to review the current evidence on the mechanism of the effect of PRP in bone deficiency healing.

Selective COX-2 inhibitor versus nonselective COX-1 and COX-2 inhibitor in the prevention of heterotopic ossification after total hip arthroplasty: a meta-analysis of randomised trials.

Whether selective cyclo-oxygenase-2 (COX-2) inhibitors are equally effective compared to nonselective NSAIDs for the prevention of heterotopic ossification (HO) after total hip arthroplasty (THA) is still unclear. We carried out a comprehensive search strategy, in which only randomised controlled trials were included. Two reviewers independently assessed methodological quality and extracted outcome data. Analyses were performed using Stata version 10.0. Four eligible randomised controlled trials totalling 808 patients were included. Meta-analysis results showed that no statistically significant difference was found in overall incidence of HO (RR 1.08; 95% CI 0.71-1.64), incidence of moderate severe HO (Brooker II and III) (RR 0.83; 95% CI 0.48-1.42) and any grade of Brooker classification between two groups. In summary, the selective COX-2 inhibitors are equally effective as nonselective NSAIDs for the prevention of HO after THA. Considering the gastrointestinal side effects of nonselective NSAIDs, we recommend selective COX-2 inhibitors for the prevention of HO after THA. However, future well-designed, randomised controlled trials are still needed to further confirm our results.

[Clinical application and advancement of artificial intervertebral discs for lumbar degenerative disease].

Degenerative disc disease is not only a common disease in the area of spinal surgery, but also one of the main reasons for the low back pain of the adults and disability. Conventionally it was considered be affirmative for the effect of the lumbar spinal fusion. But the way retained the physiological motor function. The lumbar motion segment fusion accelerated degeneration of adjacent segment disc and facet joint. Further study of lumbar functional anatomy and biomechanics made development of modern artificial disc device of different structures and materials possible. Besides the lumbar fusion, artificial lumbar disc replacement has become another choice in treating the lumbar degenerative diseases. The purpose is to release the pain which caused by the degenerative disc for a long period and to reconstruct the height of intervertebral disc in order to protect the nerve tissue. Retaining the spinal movement was in order to avoid degeneration of facet joints and adjacent segments, then, restore the spinal characteristic of kinematics and load at last. This review aims to explain the type of artificial lumbar intervertebral disc, the field of research and its clinical application advancement and prospects.

Osteochondral repair using porous poly(lactide-co-glycolide)/nano-hydroxyapatite hybrid scaffolds with undifferentiated mesenchymal stem cells in a rat model.

In this study, a novel three-dimensional poly (lactide-co-glycolide) (PLGA)/nano-hydroxyapatite (NHA) scaffold was fabricated by a thermally induced phase separation technique and its potential application in cartilage tissue-engineering was investigated. The PLGA scaffold was used as a control and mesenchymal stem cells (MSCs) were seeded in both scaffolds. After 12-days culture, SEM images and confocal laser scanning microscopy illustrated that MSCs attached more moderately and more cells distributed in PLGA/NHA scaffolds. MTT test and DNA assay showed that the viability and proliferation of MSCs in PLGA/NHA scaffolds were significantly superior to PLGA scaffolds during in vitro culture. Through in vivo study, the efficacy of this scaffold combining with MSCs for repairing articular osteochondral defects was evaluated in a rat model. Osteochondral defects in rats knees were left untreated, or treated with PLGA/NHA-MSCs composites or PLGA-MSCs composites. Twelve weeks after operation, histological examination revealed that the defects in the PLGA/NHA-MSCs treated group were filled with smooth and hyaline-like cartilage with abundant glycosaminoglycan and collagen type II deposition, but deficient in collagen type I at 12 weeks after operation. To investigate the final fate of MSCs transplanted into the defect areas, the fluorescent dye CM-DiI was used to prelabel cells. At 12 weeks after transplantation, we still observed the red fluorescence in the repair area. These findings suggest that the PLGA/NHA-MSCs composite may be potentially used for cartilage repair in clinical application. (c) 2010 Wiley Periodicals, Inc. J Biomed Mater Res, 2010.