Synergistic effects of titania nanotubes and silicon to enhance the osteogenic activity.

In this study, titania nanotubes (TNTs) incorporating silicon (Si) were formed on Ti disks using anodization and electron beam evaporation (EBE) technology to improve the osteogenic activity. The amount of Si was exquisitely adjusted by controlling the duration of EBE to optimize the biofunctionality. As the Si was incorporated, the samples exhibited hydrophilic surfaces. Long lasting and controllable Si release was observed from the EBE-modified samples without cytotoxicity. Moreover, initial cell adhesion, spreading, proliferation and osteogenic differentiation of MC3T3-E1 cells were evaluated. The results showed a notable enhancement of spreading, osteogenesis and differentiation of cells on silicon-coated TNTs (Si-TNTs). In particular, samples with highest amount of silicon (∼5.93% Si) displayed greatest augmentation of ALP activity, osteogenic-related gene expression and mineralization compared to the others in the present study. It was indicated that the modification with TNTs and appropriated Si content resulted in enhanced osteoblastic spreading, proliferation and differentiation, and therefore has the potential for future applications in the field of orthopedics.

Delayed total hip arthroplasty after failed treatment of acetabular fractures: an 8- to 17-year follow-up study.

BACKGROUND: Delayed total hip arthroplasty (THA) is a reliable procedure following failed treatment of acetabular fractures. The aim of the present study was to evaluate the influence of the type of fracture treatment and modern ceramic bearing on the clinical outcomes of delayed THA. METHODS: Between January 1997 and January 2008, 33 patients (33 hips) underwent cementless THA after failed acetabular fractures. Twenty-one were initially treated by open reduction internal fixation (ORIF) and 12 had non-ORIF. Joint articulation was either conventional metal-on-polyethylene (MOP) or ceramic-on-ceramic (COC). Intraoperative measures and preoperative and follow-up clinical, radiological, and functional outcomes were compared between the ORIF and non-ORIF groups. RESULTS: Surgery duration, blood loss, and transfusion requirement were greater in the ORIF group than in the non-ORIF group (p < 0.05). Significant improvement in Harris Hip Scores was seen post-surgery in both groups. However, a significant difference in the mean Harris Hip Score was not observed between the two groups (p = 0.57). Six patients in the ORIF group required acetabular reconstructive procedures to address bony defects compared to seven patients in the non-ORIF group (p = 0.09). The rate of anatomical restoration was 58.3% (7/12) in the non-ORIF group and 42.9% (9/21) in the ORIF group (p = 0.12). Radiolucent lines were observed in the MOP group and none in the COC group. Overall survival rate was similar in both groups (p = 0.85): 89.3% in the ORIF group and 87.5% in the non-ORIF group. CONCLUSION: Delayed THA with previous acetabular fractures is a challenging procedure. Initial fracture treatment does not influence the outcome of delayed THA, and modern ceramic bearing has promising results in the long-term follow-up.

[Percutaneous vertebroplasty and open vertebroplasty for metastatic spinal tumor].

OBJECTIVE: To explore the clinical application and therapeutic effect of percutaneous vertebroplasty(PVP) and open vertebroplasty for metastatic spinal tumor. METHODS: The clinical data of 126 patients with metastatic spinal tumor underwent surgery and obtained follow-up from January 2012 to March 2016 were retrospectively analyzed. These 126 cases were divided into two groups according to different operative methods. The metastatic tumor of 43 cases encroached vertebral canal oppressing spinal cord and nerve root, they were treated with open operation(open vertebroplasty group);and other 83 cases without obviously spinal cord or nerve root compression, or unfit for open operation, were treated with PVP (percutaneous vertebroplasty group) . VAS score, ECOG and Frankel grade were used to evaluate the pain and neurofunction in two groups.All out-hospital patients were followed up every 3 months for 1 time. X-ray, CT, MRI were examined in follow-up. RESULTS: A total of 112 vertebrae underwent PVP with the median surgical time of 50 min;VAS scores decreased significantly at 2 days after operation, which maintained till 1 month later; ECOG grade at 1 month decreased significantly;44 of 112 vertebrae suffered from asymptomatic bone cement leakage, no complications such as nerve injury or pulmonary embolism was found; the median survival time was 16 months. While for open vertebroplasty group, the median surgical time was 160 min and blood loss was 1 000 ml; postoperative VAS scores and ECOG grade at 1 month decreased significantly. Postoperative Frankel grade of 36 patients got improvement in 41 patients with spinal cord functional disturbance(87.8%); and 29 of 40 patients with incompleteness out of motor function were full recovery(76.3%); 12 cases (27.9%) occurred complications and the median survival time was 11 months. CONCLUSIONS: The different vertebroplasty treatments can be selected for patients with metastatic spinal tumor, which can relieve the pain, improve the nerve function, reconstruct the spinal stabilization, maintain the local control and raise the life quality.

Mid term results of total hip arthroplasty using polyethylene-ceramic composite (Sandwich) liner.

BACKGROUND: Ceramic-on-ceramic (COC) couplings are an attractive alternative bearing surfaces that have been reported to eliminate or reduce problems related to polyethylene wear debris. However, the material in total hip arthroplasty (THA) remains one of the major concern regarding the risk of fracture. The present study aims at reporting the fracture rate of bearings in a series of COC THAs with the use of a sandwich liner and attempt to detect the relative risk factors, the possible cause and assess the clinical results. MATERIALS AND METHODS: We retrospectively evaluated 153 patients (163 hips) using the sandwich liner COC THA between 2001 and 2009. Patient assessment was based on demographic factors, including age, weight, gender and body-mass index (BMI). All patients were evaluated clinically and radiographically or using computed tomography viz-a-viz dislocation, osteolysis, periprosthetic fracture, infection, loosening and implant fracture. RESULTS: Three ceramic sandwich liners fracture (1.84%) were observed at an average of 7.3 years' followup. The factors which were found to be non-significant to the ceramic liner fracture, included age (P = 0.205), weight (P = 0.241), gender (P = 0.553), BMI (P = 0.736), inclination (P = 0.199) and anteversion (P = 0.223). The overall survival was 91.4% at 12-year with revision as the endpoint. Other complications included osteolysis in 4 (2.45%), dislocation in one and periprosthetic fracture in one. In no hip aseptic loosening of the implants was seen. CONCLUSIONS: Our experience with the ceramic-polyethylene sandwich liner acetabular component has been disappointing because of the high rate of fracture and osteolyis. We have discontinued the use of this device and recommend the same.

Ceramic-on-ceramic bearings total hip arthroplasty in young patients.

BACKGROUND: The results of ceramic-on-ceramic (CoC) total hip arthroplasty (THA) in younger patients were not univocal. This study aims to evaluate the results of CoC bearing THA in patients younger than 50 years. METHODS: A total of 90 younger patients performed CoC THAs during March 2003 and May 2008 were included in this study. Hip function and activity were evaluated with Harris hip score and University of California Los Angeles activity score. We had discussed survival rates, radiological findings of component loosening or osteolysis, and ceramic-related complications in these patients. RESULTS: The mean Harris hip score increased from 46.3 ± 12.0 points (range, 28-70 points) before surgery to 92.5 ± 5.6 points (range, 78-100 points) at the final follow-up. The mean preoperative University of California Los Angeles activity score was 4.2 ± 1.1 points (range, 2-6 points), which improved to a mean of 7.2 ± 1.3 points (range, 4-10 points). At the time of the last follow-up, there was found to be 1 occurrence of hip dislocation, 1 squeaking, and 2 "sandwich" ceramic liners fractured during normal activity of daily living. No hips showed osteolysis or required revision for aseptic loosening. Kaplan-Meier survivorship with revision due to loosening or osteolysis was 100% and with revision due to ceramic fracture was 97.3% (95% confidence interval, 93.7%-100%) at a mean of 9.4 years. CONCLUSIONS: This study with the use of CoC bearings THAs in younger patients have shown promising results and higher rate of survivorship without evidence of osteolysis.

Tension band wiring through double-cannulated screws as a new internal fixation method for treatment of olecranon fractures: a randomized comparative study.

OBJECTIVE: The aim of this study was to assess the therapeutic effects and complications of tension band wiring (TBW) through the use of double-cannulated screws versus conventional TBW in the treatment of olecranon fractures. METHODS: Eligible participants were randomly assigned to 2 groups to undergo different methods of fixation. The related indices and data of the 2 groups were collected for comparative analysis after an average follow-up of 32.7±6.6 months. RESULTS: Average fracture healing time was 11.4 weeks in the double-screw TBW group and 12.6±1.8 weeks in the conventional TBW group (p=0.000). There was significant difference in complications related to fixation between the 2 groups. In the double-screw TBW group (42 patients), 2 patients felt screw head prominence with no pain and requested no further intervention; in contrast, 21 patients experienced complications associated with internal fixation in the conventional TBW group. Mean Mayo Elbow Performance Score (MEPS) score was 87.90±6.0 in the double-screw TBW group, compared to 83.67±6.6 in the conventional TBW group at 24-month follow-up (p=0.002). The rate of elbow function in the double-screw TBW group (29/42, 69.05%) was higher than that of the conventional TBW group (16/46, 34.78%) (p=0.000). CONCLUSION: In comparison with conventional TBW, TBW with double-cannulated screws can significantly reduce complications, lower reoperation rate, improve elbow function, shorten healing time, as well as diminish surgical trauma.

Is tumor length a prognostic indicator for esophageal squamous cell carcinoma? A single larger study among Chinese patients.

OBJECTIVE: In esophageal cancer, depth of wall penetration, reflected by T classification, represents the most important prognostic variable. Our study aimed to investigate the impact of tumor length, measured as the longitudinal length, on the outcome of esophageal squamous cell carcinoma (ESCC) patients. METHODS: The survival data of 362 ESCC patients who underwent surgical resection as the primary treatment between 1999 and 2007 were collected retrospectively. Receiver-operator characteristic analysis was applied to identify the optimal cut-off values. RESULTS: 4.0 cm was identified as the optimal cut-off value within the whole group. Tumor length greater than 4.0 cm was associated with increasing T stage (P=0.001), N stage (P=0.046), and tumor differentiation (P=0.033). Univariate analysis and multivariate analysis both found that tumor length greater than 4.0 cm was associated with worse overall survival compared with shorter tumors (P<0.001). It appeared to have a greater impact on N0-N1 (P<0.001, P=0.026, respectively) than N2-N3 and appeared to have a higher impact on the lower-stage patients than the higher-stage patients. CONCLUSIONS: Tumor length proved to be an independent prognostic parameter for ESCC patients, especially for node-negative and lower-stage patients. More attention should be paid to its role in the management of ESCC.

[Application of Ivor-Lewis esophagectomy in elderly patients with carcinoma in middle and lower esophagus].

OBJECTIVE: To evaluate the safety of Ivor-Lewis procedure for middle and lower esophageal carcinoma in the elderly. METHODS: From June 2009 to June 2010, 232 cases aged over 60 years were diagnosed as esophageal carcinoma. These cases were randomly divided into two groups using table of random digits. One group underwent abdominal and right chest approaches for middle and lower esophageal carcinoma (Ivor-Lewis procedure, n=116). The other group underwent posterolateral left thoracal incisions(Sweet procedure, n=116). Intraoperative and postoperative parameters were compared. RESULTS: The radical resection rates in Ivor-Lewis and Sweet procedure were 95.7% and 92.2% respectively(P>0.05). The time required for opening the thorax was(47.2 ± 5.2) min and (105.4 ± 9.3) min(P=0.000), respectively. The respiratory failure rates were 1.7% and 6.9%(P=0.049). The incidences of supraventricular tachyarrhythmia were 3.4% and 10.3%, respectively. The overall complication rates were 22.4% and 34.5%(P=0.004). The perioperative mortalities were 1.7% and 3.4%(P>0.05). The postoperative ambulation time was (4.0 ± 2.0)d and (4.8 ± 3.7)d(P=0.046). The postoperative time in hospital was (11.5 ± 4.7)d and (13.7 ± 7.8)d(P=0.008). CONCLUSIONS: Ivor-Lewis procedure is associated with little damage to diaphragm, shorter intrathoracic operative time, minimal influence on cardiopulmonary function, less postoperative complications, and quicker recovery. This procedure should be considered as the first choice for middle and lower esophageal carcinoma in the elderly.

Expression of e-cadherin and beta-catenin in human esophageal squamous cell carcinoma: relationships with prognosis.

AIM: To elucidate the expression of E-cadherin and beta-catenin correlating with its clinical outcome in patients with esophageal squamous cell carcinoma (ESCC), by analyzing their interrelationship with clinicopathological variables and their effects on progress and prognosis. METHODS: Expression of E-cadherin and beta-catenin was determined by SP immunohistochemical technique in patients with ESCC consecutively, their correlation with clinical characteristics was evaluated and analyzed by multivariate analysis. RESULTS: The rate of expression of E-cadherin decreased to 66.03 % (70/106) in ESCC and the protein level was negative correlated with histologic grade, tumor size, clinical staging, lymph node metastasis and venous invasion. Whereas the expression rate of beta-catenin was reduced to 69.8 % (74/106) and the level of protein expression correlated only with histologic grade. There obviously existed inverse correlation between level of E-cadherin protein and survival, especially in stage I, IIa, IIb (P=0.0033), Patients with low-expressing tumors for beta-catenin and non-expressing tumors for E-cadherin/beta-catenin had lower survival period than those with normal-expressing ones (P=0.0501 and P=0.0080, respectively). Patients with diminished expression of E-cadherin as grade II or III had shorter survival period than those with normally expressing and grade I, no significance existed between grade I and grade II or III with respect to different status of E-cadherin expression. Furthermore, Correlation analysis showed level of E-cadherin correlated with that of beta-catenin (P=0.005). Cox proportional hazards model analysis suggested downregulation of E-cadherin was an important factor indicating poor prognosis. CONCLUSION: As a probable independent prognostic factor, it correlates with overall and disease free survival period, expression of E-cadherin but not beta-catenin may predict prognosis in patients with ESCC.