ObjectiveTo investigate the effect of all-trans retinoic acid (ATRA) and vascular endothelial growth factor (VEGF) on the osteogenic differentiation of mouse embryonic fibroblasts (MEFs).MethodsThe fetal mice in the uterus of NIH pregnant mice (pregnancy 12-15 days) were collected, and the heads and hearts etc. were removed. Then MEFs were separated from the rest tissues of the fetal mice and cultured by trypsin digestion and adherent culture. HEK-293 cells were used to obtain recombinant adenovirus-red fluorescent protein (Ad-RFP) and Ad-VEGF by repeatedly freezing and thawing. Alkaline phosphatase (ALP) staining and quantitative detection were used to detect the changes of ALP activity in MEFs applied with ATRA or VEGF alone or combined use of ATRA and VEGF on the 3rd and 5th days. The cultured 3rd to 4th generation MEFs were divided into groups A, B, C, and D, and were cultured with DMSO plus Ad-RFP, ATRA, Ad-VEGF, ATRA plus Ad-VEGF, respectively. Real-time fluorescence quantitative PCR (qRT-PCR) was used to detect the mRNA expressions of osteogenic markers including ALP, collagen type Ⅰ, osteopontin (OPN), osteocalcin (OCN), and angiogenic markers including VEGF, angiopoietin 1 (ANGPT1), and endomucin (EMCN) on the 3rd and 7th days. Immunohistochemical staining was used to detect the protein expressions of OPN and VEGF on the 3rd, 5th, and 7th days in each group. Alizarin red staining was used to detect calcium salt deposition levels in each group at 14 and 21 days after osteogenic induction. Fifteen athymic female nude mice aged 4 to 6 weeks were randomly divided into 3 groups and 5 mice in each group. Then MEFs treated with ATRA, Ad-VEGF, and ATRA plus Ad-VEGF were injected subcutaneously into the dorsal and ventral sides, respectively. X-ray observation, gross observation, and histological staining (Masson, HE, and Safranin O-fast green stainings) were performed at 5 weeks after implantation to observe the ectopic bone formation in nude mice in each group.ResultsMEFs were successfully isolated and cultured. The acquired Ad-RFP and Ad-VEGF were successfully transfected into MEFs with approximately 50% and 20% transfection rates. ALP activity tests showed that ATRA or Ad-VEGF could enhance ALP activity in MEFs (P<0.05), and ATRA had a stronger effect than Ad-VEGF; and the combined use of ATRA and Ad-VEGF significantly enhanced the ALP activity in MEFs (P<0.05). qRT-PCR test showed that the combined use of ATRA and Ad-VEGF also increased the relative mRNA expressions of early-stage osteogenesis-related markers ALP, OPN, and collagen type I (P<0.05); the relative mRNA expressions of angiogenesis-related markers VEGF, EMCN, and ANGPT1 increased at 7 days (P<0.05). Immunohistochemical staining showed that ATRA combined with Ad-VEGF not only enhanced OPN protein expression, but also increased VEGF protein expression on 7th day. Alizarin red staining showed that the application of ATRA or Ad-VEGF induced weak calcium salt deposition, and the combined use of ATRA and Ad-VEGF significantly enhanced the effect of calcium salt deposition in MEFs. The results of implantation experiments in nude mice showed that X-ray films observation revealed obvious bone mass in the ATRA plus Ad-VEGF group, and the bone was larger than that in other groups. Histological staining showed a large amount of collagen and mature bone trabeculae, bone matrix formation, and gray-green collagen bone tissue, indicating that the combined use of ATRA and Ad-VEGF significantly enhanced the osteogenic effect of MEFs in vivo.ConclusionThe combined use of ATRA and VEGF can induce the osteogenic differentiation of MEFs.
ObjectiveTo explore the clinical characteristics, clinical classification, and treatment of wrist gouty arthritis. Methods The clinical data of 24 patients with wrist gouty arthritis and complete follow-up between April 2011 and August 2020 were retrospectively analyzed. There were 21 males and 3 females; the first onset age was 21-72 years, with a median age of 50 years. There were 15 cases of simple wrist joint disease, and 9 cases of other joints (hand, knee, ankle, metatarsophalangeal joint) involvement; 19 cases of wrist joint as the first site. Except for 1 patient with a medical history of 21 years, the time from onset to diagnosis in the remaining 23 patients was 7 days to 9 years, with a median time of 2 months. According to the clinical manifestations, imaging manifestations, lesion range, and intraoperative wrist arthroscopy manifestations of wrist gouty arthritis, they were classified into 5 types from mild to severe. Among the 24 patients, 13 were type Ⅰ, 2 were type ⅡA, 3 were type ⅡB, 2 were type ⅢA, 3 were type Ⅳ, and 1 was type Ⅴ. The time from first onset to diagnosis for type Ⅰ and type Ⅱ patients was (12.7±40.1) months, and for type Ⅲ-Ⅴ patients was (152.0± 88.5) months, the difference was significant (t=−4.355, P=0.001). Thirteen patients with type Ⅰ received conservative treatment (including diet, exercise, lifestyle intervention, and medication), and 11 patients with type Ⅱ-Ⅴ received surgical treatment (including 1 case of arthroscopic synovial membrane and gout crystal clearing, 1 case of ligament repair, 5 cases of lesion debridement/artificial bone grafting and filling, 3 cases of wrist fusion, and 1 case of tophicectomy). Before and after treatment, the visual analogue scale (VAS) score was used to evaluate the improvement of wrist joint pain; and the range of motion of the wrist joint (including palmar flexion, dorsal extension, radial deviation, and ulnar deviation) was evaluated. ResultsThirteen conservatively treated patients were followed up 10 months to9 years, with an average of 2.2 years. The VAS scores before treatment and at last follow-up were 6.8±0.7 and 2.9±0.9, respectively, and the difference was significant (t=12.309, P=0.000). During follow-up, there was no wrist bone and wrist joint damage; wrist joint range of motion basically reached normal. At last follow-up, the wrist joint palmar flexion, dorsal extension, radial deviation, and ulnar deviation significantly improved when compared with the values before treatment (P<0.05). Eleven surgically treated patients were followed up 5 months to 9 years, with an average of 4.9 years. The swelling and pain of all patients fully relieved, and the VAS scores were 7.3±0.8 before operation, 2.7±0.6 at 1 month after operation, and 2.5±0.6 at last follow-up, which significantly improved after operation (P<0.05); there was no significant difference between 1 month after operation and last follow-up (P>0.05). Excluded 3 patients who underwent wrist fusion, the other 8 patients had significantly improved wrist joint palmar flexion, dorsal extension, radial deviation, and ulnar deviation at last follow-up (P<0.05). The patient’s subjective satisfaction with the surgical results reached 100%. Conclusion A missed diagnosis or misdiagnosis of wrist gouty arthritis will greatly damage the wrist stability and functions. Early and proper interventions can effectively retard the progress of the disease. For the late-stage cases, a staged surgical protocol is recommended.
ObjectiveTo analyze the changing trend of cancer burden in China from 2005 to 2020, so as to provide reference for the formulation of cancer prevention and control strategies. MethodBased on the report “National and subnational trends in cancer burden in China, 2005–20”, the overall changes in cancer deaths in China by gender, age, urban and rural areas, and different regions of the country were analyzed. Results① Among the whole population, the number of cancer-related deaths and years of life lost (YLLs) in China increased by 21.6% and 5.0% respectively, and the top third leading cause of cancer-related deaths ranked by mortality rate were tracheal, bronchus, and lung cancer, liver cancer, and stomach cancer. ② In different gender groups, for the males, the top five leading cause of cancer-related deaths by mortality rate remained unchanged from 2005 to 2020, they were tracheal, bronchus, and lung cancer, liver cancer, stomach cancer, oesophageal cancer, and colon and rectum cancer. The average annual percent change (AAPC) of the age-standardized mortality rate (ASMR) increased in 4 of the leading 10 cancers, followed by prostate cancer (1.70 per 100 000), pancreatic cancer (0.95 per 100 000), lymphoma (0.33 per 100 000), and colon and rectum cancer (0.31 per 100 000). For the females, the tracheal, bronchus, and lung cancer remained the first leading cancer from 2005 to 2020, the second to the fifth leading cancers by mortality rate showed evident changes, with the liver cancer moving from the third to the second position, the stomach cancer moving from the second to the third position, the colon and rectum cancers moving from the fifth to the fourth position, and the breast cancer moving from the sixth to the fifth position, the pancreatic cancer moving from the ninth to the eighth position. Among the top 10 cancers, only the pancreatic cancer had an increase in AAPC of ASMR (0.67 per 100 000). ③ Among different age groups, the cancer-related mortality in young people (18–44 years old) and middle-aged people (45–59 years old) was much lower than that of the elderly (over 60 years old). ④ The mortality and YLL rates due to cancer in rural areas were higher than those in urban areas for both sexes. The cancer mortality rates of 11 provinces or regions such as Anhui were higher than those the national average value. The mortality, ASMR, YLL rates, and age-standardized YLL rates of all cancer types in Guangxi Zhuang Autonomous Region, Hebei, Xinjiang Uygur Autonomous Region, Henan, and Qinghai decreased in the males and which in Jiangsu, Henan, Guangxi Zhuang Autonomous Region, Xinjiang Uygur Autonomous Region, and Shanghai in the females also decreased. The ASMR of the colon and rectum cancer and pancreatic cancer increased significantly in some provinces or regions.ConclusionsFrom 2005 to 2020, there are rising trends in the number of cancer-related deaths and YLLs in China, and there are differences in the gender, age, urban and rural, and regional distribution of cancer burden. The prevention and control situation is grim, there is an urgent need for a comprehensive cancer prevention and control strategy to deal with the changing cancer burden in China.
Objective To explore the osteogenesis and angiogenesis effect of bone marrow mesenchymal stem cells (BMSCs) derived osteoblasts and endothelial cells compound with chitosan/hydroxyapatite (CS/HA) scaffold in repairing radialdefect in rats. Methods The BMSCs were isolated from Sprague Dawley rats and the 3rd generation of BMSCs were induced into osteoblasts and endothelial cells. The endothelial cells, osteoblasts, and mixed osteoblasts and endothelial cells (1 ∶ 1) were compound with CS/HA scaffold in groups A, B, and C respectively to prepare the cell-scaffold composites. The cell proliferation was detected by MTT. The rat radial segmental defect model was made and the 3 cell-scaffolds were implanted, respectively. At 4, 8, and 12 weeks after transplantation, the graft was harvested to perform HE staining and CD34 immunohistochemistry staining. The mRNA expressions of osteopontin (OPN) and osteoprotegerin (OPG) were detected by RT-PCR. Results Alkal ine phosphatase staining of osteoblasts showed that there were blue grains in cytoplasm at 7 days after osteogenic induction and the nuclei were stained red. CD34 immunocytochemical staining of the endothelial cells showed that there were brown grains in the cytoplasm at 14 days after angiogenesis induction. MTT test showed that the proliferation level of the cells in 3 groups increased with the time. HE staining showed that no obvious osteoid formation, denser microvessel, and more fibrous tissue were seen at 12 weeks in group A; homogeneous osteoid which distributed with cord or island, and many osteoblast-l ike cells were seen in groups B and C. The microvessel density was significantly higher in groups A and C than group B at 3 time points (P lt; 0.05), and in group A than in group C at 12 weeks (P lt; 0.05). The OPN and OPG mRNA expressions of group A were significantly lower than those of groups B and C at 3 time points (P lt; 0.05). In groups B and C, the OPN mRNA expressions reached peak t8 and 12 weeks, respectively, and OPG mRNA expressions reached peak at 4 weeks. Conclusion BMSCs derived steoblasts and endothelial cells (1 ∶ 1) compound with CS/HA porous scaffold can promote bone formation and vascularization in bone defect and accelerate the healing of bone defect.
Objective To investigate the clinical application and complicationof the lyophilized small-segment allogeneic bone used in repairing bone defectscaused by benign bone tumor and tumor-like lesions after resection and curettage. Methods From December 1999 to December 2005, 230 patients (156 males, 74 females; age, 5-56years, averaged 32.8 years), who had bone defects caused by benign bone tumors and tumor-like lesions after surgical resection and curettage, were treated by the lyophilized small-segment allogeneic bones. The cavities left by the tumor curettage ranged in size from 1.0 cm×0.8 cm to 10.0 cm×2.0 cm, andthe bone defects were about 1.0 to 3.5 cm in diameter after the localized resection of the bones. According to the bone defect degrees, the autogenous nonvascular iliac bone and the bone allograft (0.5-30.0 g) were implanted, followed by the drainage for 2-3 days and the use of antibiotics to prevent infection. The postoperative systemic and local reactions were observed, and the regular X-ray examinations were performed to observe the bone union. ResultsThere was no significant difference in the allergic reactions, such as postoperative temperature, drained amount, and body swelling, between this kind of transplantation and the autogenous bonetransplantation. The wounds in 196 patients were healed by the first intension.The wounds in 34 patients had extravasate. Among them, the wound was healed by changing dressing in 30cases; the wound had delayed healing in 4, including 3 whose wounds were healedby changing dressing for 3-4 weeks,and 1 whose wound was healed by taking out the implants. The follow-up for 6-60 months (average, 38 months) revealed that all the patients had the allograft unions of the bones within 6-18 months after the transplantation, and only 6patients had recurrence of the tumor (3.0%). Evaluated by the Mankin,Komender and WANG Zhiqiang’s standards, 196 (85.22%) patients were satisfied with their outcomes while the other 34 (14.78%) patients were not satisfied. Conclusion The lyophilized small-segment allogeneic bone has a good compatibility and osteogenesis, when it is used in repairing bone defects caused by benign bone tumor and tumor-like lesions after resection and curettage. So, this kind of bone is a good, convenient and safe material for the bone transplantation. The important factors affecting the allograft union are as follows: the mechanical stability in the recipient region, local blood supply, and management of the bone cavity left by resection and curettage of the bone tumor.
Objective To investigate the research progress of drug-loaded antibacterial coating of orthopedic metal implants in recent years. Methods The recent literature on the drug-loaded antibacterial coating of orthopedic metal implants were reviewed. The research status, classification, and development trend of drug-loaded antibacterial coating were summarized. Results The drug-loaded antibacterial coating of orthopedic metal implants can be divided into passive release type and active release type according to the mode of drug release. Passive drug release coating can release the drug continuously regardless of whether the presence of bacteria around the implants. Active drug release coating do not release the drug unless the presence of bacteria around the implants. Conclusion The sustained and stable release of drugs is a key problem to be solved in various antibacterial coatings research. The intelligent antibacterial coating which release antibiotics only in the presence of bacteria is the future direction of development.
The saphenous vein graft (SVG) is one of the most commonly used graft in coronary artery bypass grafting. However, SVG failure is very common, significantly impacting patient prognosis. Therefore, effectively preventing SVG failure has become an urgent clinical issue and has garnered widespread attention. This article provides a review of research related to SVG failure, aiming to offer insights for clinical diagnosis, treatment and future studies.
Objective To explore the safety and feasibility of using modified Glisson pedicle transection methodin the precise hepatectomy of hepatocellular carcinoma （HCC）. Methods Sixty patients with HCC， which confirmed by postoperational pathology were admitted in the study. During the surgery of experimental group （Glisson group）， the segment pedicle were transected firstly using modified Glisson pedicle transection method. Then， the liver parenchyma was split follow the hepatic vein guided by intraoperative ultrasound. During the surgery of contrast group （Prigle group），the liver parenchyma was split using ultracision harmonic scalpel under intermittent pringle clamping of hilar. Results There were no significant difference in the amount of intraoperative bleeding， blood transfusion， as well as duration of surgery， serum alanine aminotransferase， total bilirubin， and length of hospital stay between the two groups （P＞0.05）. However， the incidence of postoperative complication was lower in Glisson group （23.3% vs. 50.0%， P＜0.05）. In addition， the length of tumor margin was more favorable in Glisson group 〔（2.3±0.7） cm vs. （1.5±0.6） cm， P＜0.05〕. The recurrence rate of Glisson group was lower than that Prigle group， but was not different significantly （P＞0.05）. Conclusions The modified Glisson pedicle transection method has the same safety as traditional method in the precise hepatectomy of HCC. And it has the advantages in lower postoperative complication and more favorable tumor margin， which may reduce the recurrence rate theoretically.
ObjectiveTo evaluate the impact of different surgical strategies for moderate functional mitral regurgitation (FMR) at the time of aortic valve replacement (AVR) on patients' prognosis.MethodsA total of 118 AVR patients, including 84 males and 34 females, aged 58.1±12.4 years, who were complicated with moderate FMR were retrospectively recruited. Patients were divided into three groups according to the treatment strategy of mitral valve: a group A (no intervention, n=11), a group B (mitral valve repair, n=51) and a group C (mitral valve replacement, n=56). The primary endpoint was the early and mid-term survival of the patients, and the secondary endpoint was the improvement of FMR.ResultsThe median follow-up time was 29.5 months. Five patients died perioperatively, all of whom were from the group C. Early postoperative FMR improvement rates in the group A and group B were 90.9% and 94.1% (P=0.694). The mid-term mortality in the three groups were 0.0%, 5.9% and 3.9%, respectively (P=0.264), while the incidences of major cardiovascular and cerebrovascular events were 0.0%, 9.8% and 17.7%, respectively (P=0.230). Improvements of FMR in the group A and group B were 100.0% and 94.3% at the mid-term follow-up (P>0.05).ConclusionFor patients receiving AVR with moderate FMR, conservative treatment or concurrent repair of mitral valve may be more reasonable, while mitral valve replacement may increase the incidence of early and mid-term adverse events.
Objective To evaluate the efficacy of preoperative low-dose oral amiodarone for the prevention of atrial fibrillation （AF） after off-pump coronary artery bypass grafting （OPCAB） in patients older than 70 years. Methods A total of 156 patients older than 70 years who underwent OPCAB in Qingdao Fuwai Cardiovascular Disease Hospital from January 2011 to June 2012 were included in this prospective，double-blind and placebo controlled study. Preoperatively，all the 156 patients were randomly divided into amiodarone group and control group. In the amiodarone group，there were 80 patients including 38 male and 42 female patients who were given oral amiodarone （trade name： Cordarone） 200 mg，three times a day，3-5 days before surgery，and amiodarone was stopped on the OPCAB day and postoperatively. Preoperative duration of amiodarone intake was 4.0±1.2 days，and total amiodarone dosage was 2.6±0.5 g. In the control group，there were 76 patients including 35 male and 41 female patients who were given oral placebo as the same medication schedule，and preoperative duration of placebo intake was 4.0±1.4 days. Operation time，graft number，postoperative AF incidence，AF duration，hospital stay and readmission rate for cardiovascular events within 6 postoperative months were compared between the two groups. Results There was no in-hospital death in either group. There was no statistical difference in graft number，operation time，AF duration of patients who had postoperative AF，or postoperative hospital stay between the two groups. Postoperative AF incidence of the amiodarone group was significantly lower than that of the control group ［18.7% （15/80） vs. 34.2% （26/76），P=0.028］. Seventy-three patients in the amiodarone group （91.3%） and 66 patients in the control group （86.8%） were followed up for 8-24 months. During follow-up，2 patients in the amiodarone group died of acute myocardial infarction and cerebral hemorrhage respectively. There was no statistical difference in readmission rate for cardiovascular events within 6 postoperative months between the 2 groups ［6.8% （5/73） vs. 6.1% （4/66），P=0.860］ .Conclusion Preoperative low-dose oral amiodarone can significantly reduce the incidence of postoperative AF in patients older than 70 years undergoing OPCAB.