Objective To explore the label ing efficiency and cellular viabil ity of rabbit BMSCs labeled with different concentrations of superparamagnetic iron oxide (SPIO) particles, and to determine the feasibil ity of magnetically labeled stem cells with MR imaging. Methods The BMSCs were collected from il iac marrow of 10 adult rabbits (weighing 2.5-3.0 kg) and cultured. The SPIO-poly-L-lysine compound by different ratios mixed with medium, therefore, the final concentration of Fe2+ was 150 (group A), 100 (group B), 50 (group C) and 25 μg (group D) per mL, respectively, the 3rd generation BMSCs culture edium was added to lable; non-labeled cells served as a control (group E). MR imaging of cell suspensions was performed by using T1WI and T2WI sequences at a cl inical 1.5 T MRI system. Results BMSCs were efficiently labeled with SPIO, labeled SPIO particles were stained in all cytoplasms of groups A, B, C and D. With the increasing of Fe2+ concentration, blue dye particles increased. The staining result was negative in group E. The cell viabil ity in groups A, B, C, D and E was 69.20% ± 6.11%, 80.41% ± 2.42%, 94.32% ± 0.67%, 96.24% ± 0.34% and 97.43% ± 0.33%, respectively. There were statistically significant differences between groups A, B and groups C, D and E (P lt; 0.05), and between group A and group B (P lt; 0.05). T1WI images had no specific difference among 5 groups, T2WI images decreased significantly in groups A, B, C, decreased sl ightly in group D, and had l ittle change in group E. The T2WI signal intensities of groups A, B, C, D and E were 23.37 ± 6.21, 26.73 ± 3.60, 29.63 ± 2.82, 45.03 ± 6.76 and 783.15 ± 7.38, respectively, showing significant difference between groups A, B, C, D and group E (P lt; 0.05), and between groups A, B, C and group D (Plt; 0.05). Conclusion BMSCs can be easily and efficiently labeled by SPIO without interference on the cell viabil ity in labled concentration of 20-50 μg Fe2+ per mL. MRI visual ization of SPIO labeled BMSCs is feasible, which may be critical for future experimental studies.
ObjectiveTo understand the follow-up needs of postoperative patients with thyroid cancer and analyze its influencing factors, so as to provide a reference for the establishment of a follow-up management system for patients with thyroid cancer.MethodsConvenience sampling was used to conduct a questionnaire survey on the follow-up need, recovery, anxiety, and stress of patients after thyroid cancer surgery in 2 tertiary A hospitals from March to April in 2020. The self-designed follow-up needs questionnaire, the Quality of Recovery Questionnaire 15 (QoR-15), the Generalized Anxiety Disorder-7 (GAD-7), and the Perceived Stress Scale (PSS-4) were scored. The higher score, the higher need, the better recovery, and the more serious anxiety and stress.ResultsIn this study, 382 questionnaires were distributed, which of 351 were returned and of 349 were valid, the valid callback rate was 99.4% (349/351). ① Follow-up needs. Follow-up form: Online platform was the preferred follow-up method (72.2%), the most patients hoped that the follow-up would be conducted by a doctor (82.5%) and hoped to start the follow-up at 1 month after the operation (67.6%) and in the afternoon (50.7%), the duration of each follow-up was 10–15 min (47.3%), and accepted the follow-up frequency of 1 times per month (41.3%) and the lifetime follow-up (69.9%). Needs degree of follow-up contents: There were 13 follow-up items requiring more than 80% of patients. The top 5 items with the higher follow-up needs score were the question on test results, returning visit guidance, knowledges of metastasis and recurrence, medication guidance, and issuance of inspection orders, and their scores were 4.78±0.47, 4.70±0.51, 4.70±0.57, 4.65±0.59, 4.57±0.64, respectively. The results of multiple linear regression analysis were found that the age (young), marital status (unmarried), medical payment method (with medical insurance), and postoperative interval (<1 month) were closely related to the follow-up needs score (P<0.05). ② Recovery, anxiety, and stress statuses: The total QoR-15 score of patients was 79.87±29.95, which was positively correlated with the total score of follow-up needs (72.93±8.52, r=0.131, P=0.014). No significant correlation was found between the total score of GAD-7 (4.77±3.59) or PSS-4 (6.51±3.10) and the total score of follow-up needs (r=0.068, P=0.207; r=0.008, P=0.881).ConclusionsYoung, unmarried, medically insured, and early postoperative patients with thyroid cancer have higher follow-up needs. Patients with better recovery after surgery have a higher follow-up needs. Medical staff should pay attention to follow-up services after discharge, rationally arrange content, frequency, and time period of follow-up according to follow-up needs of patients, so as to improve quality of medical services.
Objective To investigate the effectiveness of tunnel osteogenesis technique combined with locking plate in the treatment of aseptic non-hypertrophic nonunion of femoral shaft. MethodsThe clinical data of 23 cases of aseptic non-hypertrophic nonunion of femoral shaft treated with tunnel osteogenesis technique combined with locking plate between January 2017 and December 2020 were retrospectively analysed. There were 17 males and 6 females with an average age of 41.4 years (range, 22-72 years). There were 22 cases of closed fracture and 1 case of open fracture. The types of internal fixation at admission included intramedullary nail in 14 cases and steel plate in 9 cases. The number of nonunion operations received in the past was 0 to 1; the duration of nonunion was 6-60 months, with an average of 20.1 months. Among them, there were 17 cases of aseptic atrophic nonunion of the femoral shaft and 6 cases of dystrophic nonunion. Twenty-two cases were fixed with 90° double plates and 1 case with lateral single plate. The operation time, theoretical blood loss, hospitalization stay, nonunion healing, and postoperative complications were recorded. Harris hip function score, Lysholm knee function score, lower extremity function scale (LEFS), and short-form 36 health survey scale (SF-36) were used at last follow-up to evaluate hip and knee functions. Visual analogue scale (VAS) score was used to evaluate the relief of pain at 1 day after operation and at last follow-up. ResultsThe average operation time was 190.4 minutes, the average theoretical blood loss was 1 458.4 mL, and the average hospitalization stay was 8.2 days. All the 23 patients were followed up 9-26 months, with an average of 18.2 months. The healing time of nonunion in 22 patients was 3-12 months, with an average of 5.6 months. There were 8 cases of limb pain, 8 cases of claudication, 6 cases of limitation of knee joint movement, and 2 cases of limitation of hip joint movement. At last follow-up, the imaging of 1 patient showed that the nonunion did not heal, accompanied by pain of the affected limb, lameness, and limitation of knee joint movement. At 1 day after operation, the VAS score of 23 patients was 6.5±1.8, the pain degree was good in 7 cases, moderate in 12 cases, and poor in 4 cases; at last follow-up, the VAS score was 0.9±1.3, the pain degree was excellent in 21 cases and good in 2 cases, which were significantly better than those at 1 day after operation (t=12.234, P<0.001; Z=–5.802, P<0.001). At last follow-up, the average Harris hip function score of 22 patients with nonunion healing was 94.8, and the good rate was 100%; Lysholm knee function score averaged 94.0, and the excellent and good rate was 90.9%; LEFS score averaged 74.6; SF-36 physical functioning score averaged 85.0 and the mental health score averaged 83.6. ConclusionTunnel osteogenesis technique combined with locking plate in the treatment of aseptic non-hypertrophic nonunion of femoral shaft has a high healing rate and fewer complications, which can effectively relieve pain and improve lower limb function and quality of patients’ life.
ObjectiveTo study the biocompatibility of bioprosthetic heart valve material with a non-glutaraldehyde-based treatment, and to provide the safety data for the clinical application. MethodsAll the tests were conducted according to GB/T16886 standards. The in vitro cytotoxicity was determined by methyl thiazolyl tetrazolium assay. Fifteen guinea pigs were divided into a test group (n=10) and a control group (n=5) in the skin sensitization test. Three New Zealand white rabbits were used in the intradermal reactivity test. Five sites on both sides of the rabbit back were set as test sites and control sites, respectively. In the acute systemic toxicity test, a total of 20 ICR mice were randomly assigned to 4 groups: a test group (polar medium), a control group (polar medium), a test group (non-polar medium) and a control group (non-polar medium), 5 in each group. Forty SD rats were divided into a test group (n=20) and a control group (n=20) in the subchronic systemic toxicity test. ResultsThe viability of the 100% extracts of the bioprosthetic heart valve material with a non-glutaraldehyde-based treatment was 75.2%. The rate of positive reaction was 0.0%. The total intradermal reactivity test score was 0. There was no statistical difference in the body weight between the test group and control group in the acute systemic toxicity test. There was no statistical difference in the body weight, organ weight, organ weight/body weight ratio, blood routine test or blood biochemistry between the test group and control group in the subchronic systemic toxicity test. ConclusionThe bioprosthetic heart valve material with a non-glutaraldehyde-based treatment has satisfying biocompatibility, which conforms to relevant national standards. The material might be a promising material for application in valve replacement.
ObjectiveTo evaluate the effect of percutaneous mechanical thrombectomy (PMT) with AngioJet mechanical thrombus aspiration system for the acute deep venous thrombosis (DVT) of lower extremities. MethodsThe clinical data of 72 patients (72 limbs) with acute DVT who underwent PMT with AngioJet system from December 2015 to June 2018 in our hospital were analyzed retrospectively. ResultsOf the 72 cases, 30 cases underwent PMT alone, while 42 cases underwent PMT combined with catheter directed thrombolysis (CDT). Thrombus clearance rate of grade Ⅲ was obtained in 49 cases (68.05%), grade Ⅱ in 20 cases (27.78%), and grade Ⅰ in 3 cases (4.17%). Thirty-five cases were found with May-Thurner syndrome, and 34 cases were treated with stenting while 1 case complicated with iliac bleeding. The rates of PTS were 1.41% (1/71), 3.57% (2/56), 4.55% (2/44), and 20.00% (3/15) at 3-month, 6-month, 1-year, and 2-year after intervention, respectively. The deep vein patency rates were 86.36% (38/44) and 80.00% (12/15) at 1-year and 2-year after intervention, respectively. The iliac stent patency rates were 100% (23/23) and 87.50% (7/8) at 1-year and 2-year after intervention, respectively. ConclusionThe effect of PMT assisted with CDT for the acute DVT of lower extremities is satisfactory, but its long-term efficacy needs to be further observed.
ObjectiveTo study the hemocompatibility of bioprosthetic heart valve materials respectively based on glutaraldehyde and non-glutaraldehyde treatment. MethodsFresh bovine pericardium was treated with glutaraldehyde or non-glutaraldehyde after adipose tissue was removed. To evaluate the hemocompatibility of the two bioprosthetic heart valve materials, hemolysis test, in vitro fibrinogen adsorption experiment, platelet adhesion experiment, thrombin-antithrombin complex (TAT) test, complement activation assay and ex vivo circulation experiment were performed. ResultsThe hemolysis test results demonstrated that both of the materials showed hemolytic rates lower than 5%. The results of TAT test and complement activation assay showed no statistical differences among the two materials and the blank control group. Compared to the bioprosthetic heart valve materials with glutaraldehyde-based treatment, the materials with non-glutaraldehyde-based treatment showed significantly decreased fibrinogen adsorption, platelet adhesion and thrombosis. ConclusionCompared to the bioprosthetic heart valve materials with glutaraldehyde-based treatment, the materials with non-glutaraldehyde-based treatment show better hemocompatibility.
Objective To investigate the optimal mixing ratio of recombinant human bone morphogenetic protein 2 (rhBMP-2) with porous calcium phosphate cement (PCPC) and autologous bone as bone grafting material for the repair of large bone defects using Masquelet technique. The effect of platelet-rich plasma (PRP) on the healing of bone defects was evaluated under the optimal ratio of mixed bone. Methods Fifty-four New Zealand White rabbits were taken to establish a 2 cm long bone defect model of the ulna and treated using the Masquelet technique. Two parts of the experiment were performed in the second phase of the Masquelet technique. First, 36 modeled experimental animals were randomly divided into 4 groups (n=9) according to the mass ratio of autologous bone and rhBMP-2/PCPC. Group A: autologous bone (100%); group B: 25% autologous bone+75% rhBMP-2/PCPC; group C: 50% autologous bone+50% rhBMP-2/PCPC; group D: 75% autologous bone+25% rhBMP-2/PCPC. The animals were executed at 4, 8, and 12 weeks postoperatively for general observation, imaging observation, histological observation (HE staining), alkaline phosphatase (ALP) activity assay, and biomechanical assay (three-point bending test) were performed to assess the osteogenic ability and to determine the optimal mixing ratio. Then, 18 modeled experimental animals were randomly divided into 2 groups (n=9). The control group was implanted with the optimal mixture ratio of autologous bone+rhBMP-2/PCPC, and the experimental group was implanted with the optimal mixture ratio of autologous bone+rhBMP-2/PCPC+autologous PRP. The same method was used to observe the above indexes at 4, 8, and 12 weeks postoperatively. Results The bone healing process from callus formation to the cortical connection at the defected gap could be observed in each group after operation; new bone formation, bridging with the host bone, and bone remodeling to normal bone density were observed on imaging observation; new woven bone, new capillaries, bone marrow cavity, and other structures were observed on histological observation. The ALP activity of each group gradually increased with time (P<0.05); the ALP activity of group A was significantly higher than that of the other 3 groups at each time point after operation, and of groups C and D than group B (P<0.05); there was no significant difference between groups C and D (P>0.05). Biomechanical assay showed that the maximum load in three-point bending test of each group increased gradually with time (P<0.05), and the maximum loads of groups A and D were significantly higher than that of groups B and C at each time point after operation (P<0.05), but there was no significant difference between groups A and D (P>0.05). According to the above tests, the optimal mixing ratio was 75% autogenous bone+25% rhBMP-2/PCPC. The process of new bone formation in the experimental group and the control group was observed by gross observation, imaging examination, and histological observation, and the ability of bone formation in the experimental group was better than that in the control group. The ALP activity and maximum load increased gradually with time in both groups (P<0.05); the ALP activity and maximum load in the experimental group were significantly higher than those in the control group at each time point after operation (P<0.05), and the maximum load in the experimental group was also significantly higher than that in group A at 12 weeks after operation (P<0.05). ConclusionIn the second phase of Masquelet technique, rhBMP-2/PCPC mixed with autologous bone to fill the bone defect can treat large bone defect of rabbit ulna, and it has the best osteogenic ability when the mixing ratio is 75% autologous bone+25% rhBMP-2/PCPC. The combination of PRP can improve the osteogenic ability of rhBMP-2/PCPC and autologous bone mixture.
ObjectiveTo evaluate the effectiveness of robot-guided percutaneous fixation and decompression via small incision in treatment of advanced thoracolumbar metastases. Methods A clinical data of 57 patients with advanced thoracolumbar metastases admitted between June 2017 and January 2021 and met the selection criteria was retrospectively analyzed. Among them, 26 cases were treated with robot-guided percutaneous fixation and decompression via small incision (robot-guided group) and 31 cases with traditional open surgery (traditional group). There was no significant difference in gender, age, body mass index, lesion segment, primary tumor site, and preoperative Tokuhashi score, Tomita score, Spinal Instability Neoplastic Score (SINS), visual analogue scale (VAS) score, Oswestry disability index (ODI), Karnofsky score, and Frankel grading between groups (P>0.05). The operation time, hospital stays, hospital expenses, intraoperative blood loss, postoperative drainage volume, duration of intensive care unit (ICU) stay, blood transfusion, complications, and survival time were compared. The pedicle screw placement accuracy was evaluated according to the Gertzbein-Robbins grading by CT within 4 days after operation. The pain, function, and quality of life were evaluated by VAS score, ODI, Karnofsky score, and Frankel grading. Results During operation, 257 and 316 screws were implanted in the robot-guided group and the traditional group, respectively; and there was no significant difference in pedicle screw placement accuracy between groups (P>0.05). Compared with the traditional group, the operation time, hospital stays, duration of ICU stay were significantly shorter, and intraoperative blood loss and postoperative drainage volume were significantly lesser in the robot-guided group (P<0.05). There was no significant difference in hospital expenses, blood transfusion rate, and complications between groups (P>0.05). All patients were followed up 8-32 months (mean, 14 months). There was no significant difference in VAS scores between groups at 7 days after operation (P>0.05), but the robot-guided group was superior to the traditional group at 1 and 3 months after operation (P<0.05). The postoperative ODI change was significantly better in the robot-guided group than in the traditional group (P<0.05), and there was no significant difference in the postoperative Karnofsky score change and Frankel grading change when compared to the traditional group (P>0.05). Median overall survival time was 13 months [95%CI (10.858, 15.142) months] in the robot-guided group and 15 months [95%CI (13.349, 16.651) months] in the traditional group, with no significant difference between groups (χ2=0.561, P=0.454) . Conclusion Compared with traditional open surgery, the robot-guided percutaneous fixation and decompression via small incision can reduce operation time, hospital stays, intraoperative blood loss, blood transfusion, and complications in treatment of advanced thoracolumbar metastases.
ObjectiveTo explore the effectivenesss of simple lateral extensor digitorum communis (EDC) split approach combined with loop-plate fixation in the treatment of ulnar coronoid fracture in terrible triad of elbow (TTE).MethodsThe clinical data of 60 patients with TTE who met the selection criteria between January 2015 and May 2018 were retrospectively analyzed. There were 48 males and 12 females, aged from 18 to 60 years (mean, 37.4 years). All the patients were closed fractures. Injury causes included fall injury in 28 cases, falling from height in 20 cases, and traffic accident injury in 12 cases. All patients had no vascular and nerve injury, and the time from injury to operation was 1-14 days, with an average of 4.8 days. The height and size of the fracture of the coronal process were measured by CT and accurate classifications were made. All the 60 patients were treated with simple lateral EDC split approach combined with loop-plate to fix the ulnar coronoid fracture; 20 patients of radial head fracture were fixed with hollow screw, 32 patients with mini-plate fixation, 8 patients with radial head prosthesis replacement; 16 patients with suture and 44 patients with suture anchor to reconstruct lateral collateral ligament complex; 10 patients with residual instability of elbow joint were fixed with hinge external fixator, and others were fixed with adjustable tension brace after operation. Postoperative imaging examination was performed to evaluate fracture healing and complications, such as loosening or breakage of internal fixator, osteoarthritis, and heterotopic ossification, etc. During follow-up, the range of motion (ROM) of the elbow joint was recorded, including elbow flexion, extension, and forearm pronation, supination. Mayo elbow function score system (MEPS) was used to evaluate elbow joint function at last follow-up.ResultsAll patients were followed up 16-24 months (mean, 20.2 months). All incisions healed by first intention after operation, and no complications such as vascular nerve injury, elbow joint instability, internal fixation failure, and infection occurred; the fracture healing time was 9-17 weeks (mean, 11.7 weeks). Four cases developed elbow stiffness after operation, and all underwent elbow joint lysis with internal fixator removal within 12-15 months after operation; 10 cases developed heterotopic ossification without special treatment. At last follow-up, the ROM of elbow flexion ranged from 85° to 135° (mean, 116°), the ROM of elbow extension ranged from 0° to 20° (mean, 11°), the ROM of forearm pronation ranged from 55° to 75° (mean, 70°), and the ROM of forearm supination ranged from 60° to 90° (mean, 83°). The MEPS score ranged from 55 to 100 (mean, 86.1); the effectiveness were excellent in 40 patients, good in 10 patients, fair in 6 patients, and poor in 4 patients, with an excellent and good rate of 83.3%.ConclusionThe simple lateral EDC split approach is fully exposed, and the loop-plate can fix the ulnar coronoid fractures firmly and stably, which can restore the stability of the elbow joint, and the effectiveness is satisfactory.
Objective To investigate the short-term effectiveness of TiRobot combined with O-arm navigation system in the minimally invasive treatment of hindfoot fracture. Methods Between March 2019 and March 2021, 25 patients with hindfoot fractures were admitted. There were 14 males and 11 females, with an average age of 51.7 years (range, 19-76 years). The causes of injuries included falling from height in 17 cases and traffic accident in 8 cases. The interval between injury and operation was 1-3 days (mean, 2.1 days). There were 16 cases of calcaneus fracture, 7 cases of talus fracture, and 2 cases of calcaneus and talus fractures. According to Sanders classification criteria, the calcaneus fractures were classified as type Ⅱ in 10 cases and type Ⅲ in 8 cases; according to the Hawkins classification criteria, the talus fractures were classified as type Ⅱ in 4 cases and type Ⅲ in 5 cases. Preoperative American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score was 48.1±9.1. During operation, the fractures were fixed with the percutaneous cannulated screws with the assistance of the TiRobot combined with the O-arm navigation system. The operation time, hospital stay, and the occurrence of related complications were recorded. X-ray films were reviewed to evaluate the fracture healing and the occurrence of talus osteonecrosis, and the width, length, height, Böhler’s angle, and Gissane’s angle of the calcaneus were measured; AOFAS ankle-hindfoot score was used to evaluated the foot function. Results The operation time ranged from 47 to 71 minutes (mean, 60.5 minutes). The length of hospital stay ranged from 2 to 5 days (mean, 3.4 days). All incisions healed by first intention. All patients were followed up 12-24 months (mean, 17.3 months). One patient demonstrated hypoesthesia on the lateral side of foot after operation and recovered after symptomatic treatment. All fractures healed confirmed by X-ray films and the healing time ranged from 10 to 16 weeks (mean, 11.8 weeks). No talus osteonecrosis occurred during follow-up. There were significant differences in the width, length, height, Böhler’s angle, and Gissane’s angle of the calcaneus between pre-operation and at last follow-up (P<0.05). At last follow-up, AOFAS ankle-hindfoot score was 91.2±5.0, the difference was significant when compared with preoperative score (t=22.169, P<0.001). The results were excellent in 16 cases and good in 9 cases, with an excellent and good rate of 100%. Conclusion TiRobot combined with O-arm navigation system for minimally invasive treatment of hindfoot fractures can obtain the satisfactory short-term effectiveness, with the advantages of less surgical trauma, precise fixation, and fewer complications.