BACKGROUND Severe proximal humerus comminuted fractures are often accompanied by medial calcar comminuted fractures and loss of medial support,which are important factors that lead to internal fixation failure.The app...BACKGROUND Severe proximal humerus comminuted fractures are often accompanied by medial calcar comminuted fractures and loss of medial support,which are important factors that lead to internal fixation failure.The appropriate treatment for proximal humerus comminuted fractures has not been established.Therefore,this study assessed the outcomes of using a fibular autograft with locking plates to treat severe proximal humerus comminuted fractures.AIM To investigate the outcomes of using a fibular autograft with locking plates to treat severe proximal humerus comminuted fractures.METHODS This retrospective,comparative cohort study included two groups of patients.Group 1 comprised 22 patients and group 2 comprised 25 patients with complete follow-up data.Group 1 was treated with a fibular autograft with open reduction and locking plates to enable internal fixation.Group 2 was treated with open reduction and locking plates to enable internal fixation.The intraoperative blood loss volume from the shoulder wound,operative time,shoulder wound pain,bone fracture healing time,Constant-Murley score of the shoulder joint,preoperative Holden walking function score,Mallet score of the shoulder joint,and humeral neck-shaft angle during surgery of the two groups were compared,and the differences were analysed using an independent sample t-test.RESULTS Group 1 had a shorter mean operative time than group 2(2.25±0.30 h vs 2.76±0.44 h;P=0.000).Group 1 had a lower shoulder wound pain score on the first day after surgery than group 2(7.91±1.15 points vs 8.56±1.00 points;P=0.044).Group 1 had a shorter fracture healing time than group 2(2.68±0.48 mo vs 3.64±0.64 mo;P=0.000).Group 1 had higher Constant-Murley scores of the shoulder joint at 3,6,and 12 mo after surgery than group 2(76.64±4.02 points vs 72.72±3.02 points,86.36±3.53 points vs 82.96±3.40 points,and 87.95±2.77 points vs 84.68±2.63 points,respectively;P=0.000,0.002,and 0.000,respectively).Group 1 had higher Mallet scores of the shoulder joint at 3,6,and 12 mo after surgery than group 2(10.32±0.57 points vs 9.96±0.54 points,13.36±1.00 points vs 12.60±0.87 points,and 13.91±0.75 points vs 13.36±0.70 points,respectively;P=0.032,0.007,and 0.013,respectively).CONCLUSION Using locking plates with a fibular autograft can recreate medial support,facilitate fracture healing,and improve shoulder function;therefore,this may be an effective treatment option for severe proximal humerus comminuted fractures.展开更多
AIM: To investigate donor site's area histological and immunohistochemical knee cartilage appearances after resurfacing iatrogenic defects with biosynthetic plugs orautografts. METHODS: Thirty New Zealand White ra...AIM: To investigate donor site's area histological and immunohistochemical knee cartilage appearances after resurfacing iatrogenic defects with biosynthetic plugs orautografts. METHODS: Thirty New Zealand White rabbits were used in this study. A full-thickness cylindrical defect of 4.5 mm(diameter) × 7 mm(depth) was created with a hand drill in the femoral groove of every animal. In Group A(n = 10) the defect of the donor site was re-paired with a biosynthetic osteochondral plug, in Group B(n = 10) with an osteochondral autograft, while in Group C(control group of 10) rabbits were left untreated. RESULTS: Twenty-four weeks postoperatively, smooth articular cartilage was found macroscopically in some trocleas' surfaces; in all others, an articular surface with discontinuities was observed. Twenty-eight out of 30 animals were found with predominantly viable chondrocytes leaving the remaining two-which were found only in the control group- with partially viable chondrocytes. However, histology revealed many statistical differences between the groups as far as the International Cartilage Repair Society(ICRS) categories are concerned. Immunofluoresence also revealed the presence of collagen Ⅱ in all specimens of Group B, whereas in Group A collagen Ⅱ was found in less specimens. In Group C collagen Ⅱwas not found. CONCLUSION: The matrix, cell distribution, subchondral bone and cartilage mineralization ICRS categories showed statistically differences between the three groups. Group A was second, while group B received the best scores; the control group got the worst ICRS scores in these categories. So, the donor site area, when repairing osteochondral lesions with autografting systems, is better amended with osteochondral autograft rather than bone graft substitute implant.展开更多
With advances in biomedical methods, tissue-engineered materials have developed rapidly as an alternative to nerve autografts for the repair of peripheral nerve injuries. However, the materials selected for use in the...With advances in biomedical methods, tissue-engineered materials have developed rapidly as an alternative to nerve autografts for the repair of peripheral nerve injuries. However, the materials selected for use in the repair of peripheral nerve injuries, in particular multiple injuries and largegap defects, must be chosen carefully. Various methods and materials for protecting the healthy tissue and repairing peripheral nerve injuries have been described, and each method or material has advantages and disadvantages. Recently, a large amount of research has been focused on tissue-engineered materials for the repair of peripheral nerve injuries. Using the keywords ＂peripheral nerve injury＂, ＂autotransplant＂, ＂nerve graft＂, and ＂biomaterial＂, we retrieved publications using tissue-engineered materials for the repair of peripheral nerve injuries appearing in the Web of Science from 2010 to 2014. The country with the most total publications was the USA. The institutions that were the most productive in this field include Hannover Medical School （Germany）, Washington University （USA）, and Nantong University （China）. The total number of publications using tissue-engineered materials for the repair of peripheral nerve injuries grad- ually increased over time, as did the number of Chinese publications, suggesting that China has made many scientific contributions to this field of research.展开更多
BACKGROUND： Autograft is commonly used to repair nerve deficit. Usually, the choice of donor nerves is based on their similarities in form and structures to the injured nerves. For the reason, the cutaneous antebrach...BACKGROUND： Autograft is commonly used to repair nerve deficit. Usually, the choice of donor nerves is based on their similarities in form and structures to the injured nerves. For the reason, the cutaneous antebrachii lateralis nerve is currently considered the most suited for digital nerve repair. OBJECTIVE： To compare early nerve regeneration after transplantation of three different autografts： the greater auricular nerve （GAN）, the saphenous nerve （SN） and the lateral femoral cutaneous nerve （LFCN）. DESIGN： Observational contrast study. SETTING： Department of Plastic Surgery and Burns, Tangdu Hospital, Fourth Military Medical University of Chinese PLA. MATERIALS： A total of 42 New Zealand rabbits, of both genders, 12-14 months old and weighing 2.0- 2.5 kg, were used in this study. In addition, Moller-spetra 900 operating microscope （Germany）, Olympus BX 51 microscope, DP 70 image collecting System （Japan）, BL-420E＋ Biologic function testing System （China）, JEM-100 electron microscope （Japan）, Reichet-JunG820 Cryostat （Swiss）, and Libror-AEG-120 precision analytical Balance （Japan） were also used in this study. METHODS： The experiment was carried out in the Department of Plastic Surgery and Burns, Tangdu Hospital, Fourth Military Medical University of Chinese PLA from April to November 2005. After anaesthesia, the GAN were dissected bilaterally and a 1.2 cm deficit was made in each nerve. The animals were randomly divided into three groups, including GAN group, SN group and LFCN group with 14 in each group. ① Nerve pinch test： At 1, 2, and 4 weeks after operation, three animals in each group were tested. The nerve grafts, along with the proximal and distal GAN segments were exposed and pinched with microsurgical forceps in distal-proximal orientations. The distance between the proximal anastomosis site and the most distal point, where the pinch evoked an ear contraction response, was measured as distance of nerve regeneration. ② Computer image analysis： At 4 and 12 weeks, 2 μm sections were prepared, each stained with either HE or methylene blue to assess axon number and density, cross-section area, and myelin sheath thickness. ③ Electrophysidogical tests： At 12 weeks, the bilateral GAN along with the nerve grafts of 4 animals in each group were exposed. Points A, B and C were marked on each specimen： point A： at the proximal GAN segment, 7 cm from the proximal anastomosis; point B： 0.5 cm from the proximal anastomosis; point C： at the distal GAN segment, 0.5 cm from the distal anastomosis. The whole nerve including nerve graft and proximal and distal GAN segments, as a block, was harvested and immersed in Ren＇s solution for several minutes until its excitability was stabilized. The specimen was then placed on the electrodes of the shield box to examine the action potential and conduction velocity on segment AB and AC with BL-420E＋biologic function testing system. AC/AB would be the recovery rate of action potential on segment AC. ④ Horseradish peroxidase （HRP） fascicle： At 12 weeks, at the site on the distal segment of GAN 1.0 cm from the distal anastomosis of nerve graft, the GAN was crushed by a pair of haemostatic forceps and HRP water solution was injected into the nerve. Two rabbits in GAN group, SN group and LFCN group, after having survived for 24 hours, 36 hours and 48 hours were selected. The C2 ganglion was exposed and the distance from C2 ganglion to HRP injection site was taken as the axoplasmic transport distance, from which the axoplasmic transport velocity and the mean density of the labeled C2 ganglion cells were calculated. MAIN OUTCOME MEASURES： ① The greatest distance of nerve regeneration; ② the axon number and density, cross-section area, and myelin sheath thickness; ③ the action potential and conduction velocity; ④ the axoplasmic transport velocity and the mean density of the labeled C2 ganglion cells. RESULTS： All 42 experimental rabbits were involved in the final analysis. ① The greatest distance of nerve regeneration： At 4 weeks after operation, the greatest distance of nerve regeneration was longer in the SN group than that in the GAN group and the LFCN group [（45.17±2.48）, （41.83±2.32）, （34.83±2.64） mm, P 〈 0.05], while the greatest distance of nerve regeneration was longer in the GAN group than that in theLFCN group （P 〈 0.05）. ② The axon number and density, cross-section area, and myelin sheath thickness： The number of nerve fascicle was the greatest in the GAN group, and the cross-section area was the most; however, ratio between nerve fascicle and cross-section area, and the axon density were lower than those in other two groups （P 〈 0.05-0.01）. In contrast, the axon density was the greatest in the SN group. At 4 weeks after operation, axon density was the most in the SN group, and then the GAN group and the LFCN group. There were significant differences among the three groups （P 〈 0.05-0.01）. At 12 weeks after operation, density of myelinated fiber and axon section area were higher in the SN group than those in other two groups （P 〈 0.05-0.01）. ③ The action potential and conduction velocity： At 12 weeks after operation, the maximal action potential, the recovery rate of action potential and the nerve conduction velocity were the highest in the SN group. HRP-labeled neurons early occurred in C2 ganglion, and the action potential and the recovery rate of action potential were increased （P 〉 0.05）. At 12 weeks after operation, even though the maximal action potential, the recovery rate of action potential and the nerve conduction velocity on segment AB remained similar in different groups, on segment AC, the action potential, the recovery rate of action potential and nerve conduction velocity were greater in the SN group than those in other groups. ④ The axoplasmic transport velocity and the mean density of the labeled C2 ganglion cells： After HRP injection in the SN group, the positive labeled cells in C2 ganglion firstly appeared at 24 hours, and in other two groups, they did not appeared until 36 hours. The density of labeled cells was the greatest in the SN group and the lowest in the LFCN group. The axoplasmic transport velocity in the SN group was also significantly faster than in the GAN group and the LFCN group （P 〈 0.05-0.01）. Otherwise, the axoplasmic transport velocity was faster in the SN group than that in the GAN group and the LFCN group. CONCLUSION： The donor nerve with greater axon number and density can achieve much better effects during early regeneration.展开更多
BACKGROUND Meniscus extrusion occurs in most elderly individuals and most patients after meniscus allograft transplantation.The risk factors and correlative factors of meniscus extrusion have been extensively studied....BACKGROUND Meniscus extrusion occurs in most elderly individuals and most patients after meniscus allograft transplantation.The risk factors and correlative factors of meniscus extrusion have been extensively studied.However,for using tendon autograft for meniscus reconstruction,both graft type and surgical method are different from those in previous studies on meniscus extrusion.AIM To identify predictive factors for coronal and sagittal graft extrusion length after using tendon autograft for medial meniscus reconstruction.METHODS Ten patients who underwent medial meniscus reconstruction with tendon autograft were selected for this retrospective observational study.The graft extrusions and potential factors were measured and correlation and regression analyses were performed to analyze their relationships.RESULTS The medial graft extrusion correlated with the preoperative bilateral hip-kneeankle angle difference,preoperative Kellgren-Lawrence grade,preoperative relative joint space width,and preoperative bilateral medial edge incline angle difference.The anterior graft correlated with the anterior tunnel edge distance at 1 week after operation.The posterior graft extrusion correlated with the preoperative bilateral hip-knee-ankle angle difference,preoperative relative joint space width,and posterior tunnel edge distance at 1 week after operation.The mean graft extrusion correlated with the preoperative bilateral hip-knee-ankle angle difference and preoperative relative joint space width.The preoperative joint space width and anterior and posterior tunnel edge distance at 1 week can be used to predict the medial,anterior,posterior,and mean graft extrusion length.CONCLUSION The preoperative joint space width and tunnel position can be used to predict the coronal and sagittal graft extrusion length after using tendon autograft for medial meniscus reconstruction.展开更多
This letter addresses the recent study by Zhu et al on the predictive factors for coronal and sagittal graft extrusion length following medial meniscus reconstruction using tendon autografts.The study provides valuabl...This letter addresses the recent study by Zhu et al on the predictive factors for coronal and sagittal graft extrusion length following medial meniscus reconstruction using tendon autografts.The study provides valuable insights into the importance of preoperative joint space width and tunnel positioning as predictors of graft extrusion.Specifically,it found strong correlations between preoperative joint space width and medial,posterior,and mean graft extrusion at both 1 week and 8 months post-operation.Additionally,tunnel edge distance at 1 week postoperation correlated with anterior and posterior graft extrusion.These findings offer critical guidance for improving surgical outcomes.However,the letter highlights the need for further research with larger sample sizes and comparative studies involving different graft types to strengthen these findings and broaden their applicability in clinical settings.The study's contributions to understanding meniscus reconstruction using tendon autografts are acknowledged,along with suggestions for future research directions.展开更多
Laboratory and clinical experience with PBSCT is reviewed.At.the University of Tokushima,a total of 314 aphoresis were performed by a CS 3000 cell separator in 77 children aged 7 months to 17 years with various types ...Laboratory and clinical experience with PBSCT is reviewed.At.the University of Tokushima,a total of 314 aphoresis were performed by a CS 3000 cell separator in 77 children aged 7 months to 17 years with various types of cancer.Mobidity related to the collection was negligible and a larger number of CFU-GM was collected in younger children than in展开更多
Background Bone grafting is commonly used to repair bone defects.As the porosity of the graft scaffold increases,bone formation increases,but the strength decreases.Early attempts to engineer materials were not able t...Background Bone grafting is commonly used to repair bone defects.As the porosity of the graft scaffold increases,bone formation increases,but the strength decreases.Early attempts to engineer materials were not able to resolve this problem.In recent years,nanomaterials have demonstrated the unique ability to improve the material strength and toughness while stimulating new bone formation.In our previous studies,we synthesized a nano-scale material by reinforcing a porous β-tricalcium phosphate （β-TCP） ceramic scaffold with Na2O-MgO-P2O5-CaO bioglass （β-TCP/BG）.However,the in vivo effects of the β-TCP/BG scaffold on bone repair remain unknown.Methods We investigated the efficacy of β-TCP/BG scaffolds compared to autografts in a canine tibioflbula defect model.The tibioflbula defects were created in the right legs of 12 dogs,which were randomly assigned to either the scaffold group or the autograft group （six dogs per group）.Radiographic evaluation was performed at 0,4,8,and 12 weeks post-surgery.The involved tibias were extracted at 12 weeks and were tested to failure via a three-point bending.After the biomechanical analysis,specimens were subsequently processed for scanning electron microscopy analysis and histological evaluations.Results Radiographic evaluation at 12 weeks post-operation revealed many newly formed osseous calluses and bony unions in both groups.Both the maximum force and break force in the scaffold group （n=6） were comparable to those in the autograft group （n=6,P ＞0.05）,suggesting that the tissue-engineered bone repair achieved similar biomechanical properties to autograft bone repair.At 12 weeks post-operation,obvious new bone and blood vessel formations were observed in the artificial bone of the experimental group.Conclusions The results demonstrated that new bone formation and high bone strength were achieved in the β-TCP/ BG scaffold group,and suggested that the β-TCP/BG scaffold could be used as a synthetic alternative to autografts for the repair of bone defects.展开更多
Limbal stem cell deficiency(LSCD)causes severe vision impairment and can lead to blindness,representing one of the most challenging ocular surface disorders.Stem cell deficiency can be congenital or,more often,acquire...Limbal stem cell deficiency(LSCD)causes severe vision impairment and can lead to blindness,representing one of the most challenging ocular surface disorders.Stem cell deficiency can be congenital or,more often,acquired.The categorization of ocular surface transplantation techniques is crucial to achieving treatment homogeneity and quality of care,according to the anatomic source of the tissue being transplanted,genetic source,autologous or allogenic transplantation(to reflect histocompatibility in the latter group),and cell culture and tissue engineering techniques.The aim of this minireview is to provide a summary of the management of LSCD,from clinical characteristics and therapeutic outcomes to the development of novel therapeutic approaches.The manuscript also briefly summarizes recent findings in the current literature and outlines the future challenges to overcome in the management of the major types of ocular surface failure.展开更多
Treatment of peripheral nerve injuries remains a challenge to modern medicine due to the com-plexity of the neurobiological nerve regenerating process. There is a greater challenge when the transected nerve ends are n...Treatment of peripheral nerve injuries remains a challenge to modern medicine due to the com-plexity of the neurobiological nerve regenerating process. There is a greater challenge when the transected nerve ends are not amenable to primary end-to-end tensionless neurorraphy. When facing a segmental nerve defect, great effort has been made to develop an alternative to the au-tologous nerve graft in order to circumvent morbidity at donor site, such as neuroma formation, scarring and permanent loss of function. Tubolization techniques have been developed to bridge nerve gaps and have been extensively studied in numerous experimental and clinical trials. The use of a conduit intends to act as a vehicle for moderation and modulation of the cellular and molecular ambience for nerve regeneration. Among several conduits, vein tubes were validated for clinical application with improving outcomes over the years. This article aims to address the investigation and treatment of segmental nerve injury and draw the current panorama on the use of vein tubes as an autogenous nerve conduit.展开更多
Objective:To study the time-course of the regeneration of GAP-43+ nerve, and the effects of NGF and TrkA on this process. Methods: Adult Wistar rats underwent splenectomy and splenic autotransplantation, or sham-opera...Objective:To study the time-course of the regeneration of GAP-43+ nerve, and the effects of NGF and TrkA on this process. Methods: Adult Wistar rats underwent splenectomy and splenic autotransplantation, or sham-operation. On day 7, 14, 30, 60, 90, 120, and 180 after surgery, the density of GAP-43+ nerve fibers in spleen tissues were measured with the immunohistochemistry followed by computer image analysis. The expressions of GAP-43, NGF and TrkA were determined with in situ hybrdization, and their mRNA levels were detected with RT-PCR and image analysis qualification. Results: (1) The GAP-43+ nerve fibers began their regeneration on 30 d after operation and extended from greater omentum into splenic autotransplants. Density of the nerve fibers gradually became greater and almost normal 180 d after operation. (2) In splenic autografts, the mRNA expression of GAP-43, NGF and TrkA appeared on day 30 after the operation, gradually reached the peak on day 90. Conclusion: The renascent GAP-43+ nerve fibers may come from the greater omentum packaging the splenic autografts and NGF and TrkA can promote the nerval regeneration in the autotransplant spleen tissues.展开更多
The gold standard for treating peripheral nerve injuries that have large nerve gaps where the nerves cannot be directly sutured back together because it creates tension on the nerve,is to incorporate an autologous ner...The gold standard for treating peripheral nerve injuries that have large nerve gaps where the nerves cannot be directly sutured back together because it creates tension on the nerve,is to incorporate an autologous nerve graft.However,even with the incorporation of a nerve graft,generally patients only regain a small portion of function in limbs affected by the injury.Although,there has been some promising results using growth factors to induce more axon growth through the nerve graft,many of these previous therapies are limited in their ability to release growth factors in a sustained manner and tailor them to a desired time frame.The ideal drug delivery platform would deliver growth factors at therapeutic levels for enough time to grow axons the entire length of the nerve graft.We hypothesized that mineral coated microparticles(MCMs)would bind,stabilize and release biologically active glial cell-derived neurotrophic factor(GDNF)and nerve growth factor(NGF)in a sustained manner.Therefore,the objective of this study was to test the ability of MCMs releasing growth factors at the distal end of a 10 mm sciatic nerve graft,to induce axon growth through the nerve graft and restore hind limb function.After sciatic nerve grafting in Lewis rats,the hind limb function was tested weekly by measuring the angle of the ankle at toe lift-off while walking down a track.Twelve weeks after grafting,the grafts were harvested and myelinated axons were analyzed proximal to the graft,in the center of the graft,and distal to the graft.Under physiological conditions in vitro,the MCMs delivered a burst release of NGF and GDNF for 3 days followed by a sustained release for at least 22 days.In vivo,MCMs releasing NGF and GDNF at the distal end of sciatic nerve grafts resulted in significantly more myelinated axons extending distal to the graft when compared to rats that received nerve grafts without growth factor treatment.The rats with nerve grafts incorporated with MCMs releasing NGF and GDNF also showed significant improvement in hind limb function starting at 7 weeks postoperatively and continuing through 12 weeks postoperatively when compared to rats that received nerve grafts without growth factor treatment.In conclusion,MCMs released biologically active NGF and GDNF in a sustained manner,which significantly enhanced axon growth resulting in a significant improvement of hind limb function in rats.The animal experiments were approved by University of Wisconsin-Madison Animal Care and Use Committee(ACUC,protocol#M5958)on January 3,2018.展开更多
Osteochondral lesions of the talus(OLT) occur in up to 70% of acute ankle sprains and fractures. OLT have become increasingly recognized with the advancements in cartilage-sensitive diagnostic imaging modalities. Alth...Osteochondral lesions of the talus(OLT) occur in up to 70% of acute ankle sprains and fractures. OLT have become increasingly recognized with the advancements in cartilage-sensitive diagnostic imaging modalities. Although OLT may be treated nonoperatively, a number of surgical techniques have been described for patients whom surgery is indicated. Traditionally, treatment of symptomatic OLT have included either reparative procedures, such as bone marrow stimulation(BMS), or replacement procedures, such as autologous osteochondral transplantation(AOT). Reparative procedures are generally indicated for OLT < 150 mm^2 in area. Replacement strategies are used for large lesions or after failed primary repair procedures. Although shortand medium-term results have been reported, longterm studies on OLT treatment strategies are lacking. Biological augmentation including platelet-rich plasma and concentrated bone marrow aspirate is becoming increasingly popular for the treatment of OLT to enhance the biological environment during healing. In this review, we describe the most up-to-date clinical evidence of surgical outcomes, as well as both the mechanical and biological concerns associated with BMS and AOT. In addition, we will review the recent evidence for biological adjunct therapies that aim to improve outcomes and longevity of both BMS and AOT procedures.展开更多
There is much literature about differing grafts used in anterior cruciate ligament(ACL) reconstruction. Much of this is of poor quality and of a low evidence base. We review and summarise the literature looking at the...There is much literature about differing grafts used in anterior cruciate ligament(ACL) reconstruction. Much of this is of poor quality and of a low evidence base. We review and summarise the literature looking at the four main classes of grafts used in ACL reconstruction; bone-patella tendon-bone, hamstrings, allograft and synthetic grafts. Each graft has the evidence for its use reviewed and then compared, where possible, to the others. We conclude that although there is no clear "best" graft, there are clear differences between the differing graft choices. Surgeon's need to be aware of the evidence behind these differences, in order to have appropriate discussions with their patients, so as to come to an informed choice of graft type to best suit each individual patient and their requirements.展开更多
AIM: To find the risk factors related to the reproliferation of the pterygial tissue after excision and graft surgery.METHODS: Charts of 130 eyes of 130 patients who had pterygial excision from March 2006 to April 201...AIM: To find the risk factors related to the reproliferation of the pterygial tissue after excision and graft surgery.METHODS: Charts of 130 eyes of 130 patients who had pterygial excision from March 2006 to April 2011 were reviewed. Preoperative pterygium morphology, surgical methods, and adjunctive treatments were statistically analyzed for their relationship with recurrence.RESULTS: During the follow-up period, recurrence was observed in 20 eyes(15.4%). None of the preoperative morphologic features were affected the rate of the recurrence. However, an age 【40y [P =0.085, odds ratio(OR) 3.609, 95% confidence interval(CI) 0.838-15.540]and amniotic membrane graft instead of conjunctival autograft(P =0.002, OR 9.093, 95% CI 2.316-35.698) were statistically significant risk factors for recurrence.Multivariate analysis revealed that intraoperative mitomycin C(MMC)(P =0.072, OR 0.298, 95% CI 0.080-1.115)decreased the rate of recurrence. CONCLUSION: Younger age is a risk factor for reproliferation of pterygial tissue after excision and amniotic membrane transplantation(AMT) are less effective in preventing recurrence of pterygium after excision based on the comparison between conjunctival autograft and AMT. Intraoperative MMC application and conjunctival autograft reduce recurrence.展开更多
AIM： To compare long-term outcome of primary and recurrent pterygium surgery with three different techniques： combined conjunctival autograft and overlay amniotic membrane transplantation （CAT with AMT）, conjuncti...AIM： To compare long-term outcome of primary and recurrent pterygium surgery with three different techniques： combined conjunctival autograft and overlay amniotic membrane transplantation （CAT with AMT）, conjunctival autograft transplantation （CAT） alone and amniotic membrane transplantation （AMT） alone. METHODS： In this retrospective study, 142 eyes of 142 pterygium patients （104 primary, 38 recurrent）who underwent CAT （group A）, AMT （group B） or CAT with AMT （group C） respectively following surgical excision were reviewed and compared based on the recurrences and post-operative complications. RESULTS： The number of recurrence post-surgery were 17 （9 from primary, 8 from recurrent; the same description below）, 18 （10, 8） and 2 （1, 1） in groups A, B, and C respectively; dry eyes were 22 （16, 6）, 27 （18, 9） and 7 （3, 4）; conjunctival inflammations were 30 （17, 13）, 27 （16, 11） and 11 （6, 5）. Patients in group C （either pdmary or recurrent or both） mainly showed significantly better results than those in group A or B （P〈0.05） regarding above-mentioned clinical effects. CONCLUSION： Combined CAT and overly AMT have significantly lower rates of recurrence and postoperative complications for primary and recurrent pterygium surgery than CAT or AMT alone.展开更多
We hypothesized that a chemically extracted acellular allogeneic nerve graft used in combination with bone marrow mesenchymal stem cell transplantation would be an effective treatment for long-segment sciatic nerve de...We hypothesized that a chemically extracted acellular allogeneic nerve graft used in combination with bone marrow mesenchymal stem cell transplantation would be an effective treatment for long-segment sciatic nerve defects.To test this,we established rabbit models of 30 mm sciatic nerve defects,and treated them using either an autograft or a chemically decellularized allogeneic nerve graft with or without simultaneous transplantation of bone marrow mesenchymal stem cells.We compared the tensile properties,electrophysiological function and morphology of the damaged nerve in each group.Sciatic nerves repaired by the allogeneic nerve graft combined with stem cell transplantation showed better recovery than those repaired by the acellular allogeneic nerve graft alone,and produced similar results to those observed with the autograft.These findings confirm that a chemically extracted acellular allogeneic nerve graft combined with transplantation of bone marrow mesenchymal stem cells is an effective method of repairing long-segment sciatic nerve defects.展开更多
Current Neuroscience dogma holds that transections or ablations of a segment of peripheral nerves produce： （1） Immediate loss of axonal continuity, sensory signaling, and motor control; （2） Wallerian rapid （1-3 ...Current Neuroscience dogma holds that transections or ablations of a segment of peripheral nerves produce： （1） Immediate loss of axonal continuity, sensory signaling, and motor control; （2） Wallerian rapid （1-3 days） degeneration of severed distal axons, muscle atrophy, and poor behavioral recovery after many months （if ever, after ablations） by slowly-regenerating （1 mm/d）, proximal-stump outgrowths that must specifically reinnervate denervated targets; （3） Poor acceptance of microsutured nerve allografts, even if tissue-matched and immune-suppressed. Repair of transections/ablations by neurorrhaphy and well-specified-sequences of PEG-fusion solutions （one containing polyethylene glycol, PEG） successfully address these problems. However, conundrums and confusions regarding unorthodox and dramatic results of PEG-fusion repair in animal model systems often lead to misunderstandings. For example, （1） Axonal continuity and signaling is re-established within minutes by non-specifically PEG-fusing （connecting） severed motor and sensory axons across each lesion site, but remarkable behavioral recovery to near-unoperated levels takes several weeks; （2） Many distal stumps of inappropriately-reconnected, PEG-fused axons do not ever （Wallerian） degenerate and continuously innervate muscle fibers that undergo much less atrophy than otherwise-denervated muscle fibers; （3） Host rats do not reject PEG-fused donor nerve allografts in a non-immuno-privileged environment with no tissue matching or immunosuppression; （4） PEG fuses apposed open axonal ends or seals each shut （thereby preventing PEG-fusion）, depending on the experimental protocol; （5） PEG-fusion protocols produce similar results in animal model systems and early human case studies. Hence, iconoclastic PEG-fusion data appropriately understood might provoke a re-thinking of some Neuroscience dogma and a paradigm shift in clinical treatment of peripheral nerve injuries.展开更多
Bone defects may impede normal biomechanics and the structural stability of bone as an organ. In many cases, the correction of bone defects requires extensive surgical intervention involving the use of bone-grafting t...Bone defects may impede normal biomechanics and the structural stability of bone as an organ. In many cases, the correction of bone defects requires extensive surgical intervention involving the use of bone-grafting techniques and other procedures in which healing is slow, there is a high risk of infection and considerable pain is provoked- with no guarantee of complete correction of the defect. Therefore, the search for surgical alternatives continues to present a major challenge in orthopaedic traumatology. The reamer-irrigator-aspirator(RIA) system, which was devised to avoid the problems that can arise with autograft harvesting from the iliac crest, consists of collecting the product of the femoral canal after reaming. The RIA technique improves osteogenic differentiation of mesenchymal stem cells, compared to bone marrow aspiration or cancellous bone harvesting from the iliac crest using a spoon. Another approach, the Masquelet technique, consists of reconstructing a long bone defect by means of an induced membrane grown onto an acrylic cement rod inserted to fill the defect; in a second surgical step, once the membrane is constituted, the cement rod is removed and cancellous autograft is used to fill the defect. Both in RIA and in the Masquelet technique, osteosynthesis is usually needed. Bone transportation by compression-distraction lengthening principles is commonly implemented for the treatment of large bone loss. However, complications are frequently encountered with these techniques. Among new techniques that have been proposed to address the problem of large bone loss, the application of stem cells in conjunction with tissue engineering techniques is very promising, as is the creation of personalised medicine(or precision medicine), in which molecular profiling technologies are used to tailor the therapeutic strategy, to ensure the right method is applied for the right person at the right time, after determining the predisposition to disease among the general population. All of the above techniques for addressing bone defects are discussed in this paper.展开更多
The main purpose of this study patients undergoing a single bundle anterior was to compare the clinical outcomes of cruciate ligament reconstruction (ACL-R) of using quadrupled hamstring (4HT)autografts and two-strand...The main purpose of this study patients undergoing a single bundle anterior was to compare the clinical outcomes of cruciate ligament reconstruction (ACL-R) of using quadrupled hamstring (4HT)autografts and two-strand tibialis anterior (2TA) aUografts,and to find out the rate of graft failure and possible causes.We hypothesized that there would be no difference in the clinical outcome,and graft failure would be associated with the use of small sized allograft in young active males with high demand of sports activities.We retrospectively evaluated 222 patients (male,n=167,female,n=55) undergoing ACL-R between January 2010 and July 2014.Of 222 patients,115 were included in the 4HT autograft group and 107 patients in the 2TA allograft group.Inclusion criteria were primary unilateral ACL-R with a minor MCL (<grade Ⅱ)injury with or without meniscus tear and had at least 2.5 years of follow-up.Subjective evaluation was performed using Tegner-Lysholm score,modified Cincinnati knee score,and IKDC knee form.Anteroposterior laxity was assessed using ADT and Lachman test whereas rotational laxity was assessed using pivot shift test.Similarly,functional assessment was performed using range of motion (ROM),Daniel's one-leg hop test,and overall IKDC score.Clinical outcomes were satisfactory and comparable in both groups with no statistically significant difference in all the respective parameters.No statistically significant difference was observed in graft re-rupture rate.However,most graft failures occurred in young active males with high demand of sports activities,graft size smaller than 8 mm,and use of allograft.An autograft with at least 8 mm diameter should be considered in a young active male with high demand of sports activities to avoid graft failure.展开更多
文摘BACKGROUND Severe proximal humerus comminuted fractures are often accompanied by medial calcar comminuted fractures and loss of medial support,which are important factors that lead to internal fixation failure.The appropriate treatment for proximal humerus comminuted fractures has not been established.Therefore,this study assessed the outcomes of using a fibular autograft with locking plates to treat severe proximal humerus comminuted fractures.AIM To investigate the outcomes of using a fibular autograft with locking plates to treat severe proximal humerus comminuted fractures.METHODS This retrospective,comparative cohort study included two groups of patients.Group 1 comprised 22 patients and group 2 comprised 25 patients with complete follow-up data.Group 1 was treated with a fibular autograft with open reduction and locking plates to enable internal fixation.Group 2 was treated with open reduction and locking plates to enable internal fixation.The intraoperative blood loss volume from the shoulder wound,operative time,shoulder wound pain,bone fracture healing time,Constant-Murley score of the shoulder joint,preoperative Holden walking function score,Mallet score of the shoulder joint,and humeral neck-shaft angle during surgery of the two groups were compared,and the differences were analysed using an independent sample t-test.RESULTS Group 1 had a shorter mean operative time than group 2(2.25±0.30 h vs 2.76±0.44 h;P=0.000).Group 1 had a lower shoulder wound pain score on the first day after surgery than group 2(7.91±1.15 points vs 8.56±1.00 points;P=0.044).Group 1 had a shorter fracture healing time than group 2(2.68±0.48 mo vs 3.64±0.64 mo;P=0.000).Group 1 had higher Constant-Murley scores of the shoulder joint at 3,6,and 12 mo after surgery than group 2(76.64±4.02 points vs 72.72±3.02 points,86.36±3.53 points vs 82.96±3.40 points,and 87.95±2.77 points vs 84.68±2.63 points,respectively;P=0.000,0.002,and 0.000,respectively).Group 1 had higher Mallet scores of the shoulder joint at 3,6,and 12 mo after surgery than group 2(10.32±0.57 points vs 9.96±0.54 points,13.36±1.00 points vs 12.60±0.87 points,and 13.91±0.75 points vs 13.36±0.70 points,respectively;P=0.032,0.007,and 0.013,respectively).CONCLUSION Using locking plates with a fibular autograft can recreate medial support,facilitate fracture healing,and improve shoulder function;therefore,this may be an effective treatment option for severe proximal humerus comminuted fractures.
文摘AIM: To investigate donor site's area histological and immunohistochemical knee cartilage appearances after resurfacing iatrogenic defects with biosynthetic plugs orautografts. METHODS: Thirty New Zealand White rabbits were used in this study. A full-thickness cylindrical defect of 4.5 mm(diameter) × 7 mm(depth) was created with a hand drill in the femoral groove of every animal. In Group A(n = 10) the defect of the donor site was re-paired with a biosynthetic osteochondral plug, in Group B(n = 10) with an osteochondral autograft, while in Group C(control group of 10) rabbits were left untreated. RESULTS: Twenty-four weeks postoperatively, smooth articular cartilage was found macroscopically in some trocleas' surfaces; in all others, an articular surface with discontinuities was observed. Twenty-eight out of 30 animals were found with predominantly viable chondrocytes leaving the remaining two-which were found only in the control group- with partially viable chondrocytes. However, histology revealed many statistical differences between the groups as far as the International Cartilage Repair Society(ICRS) categories are concerned. Immunofluoresence also revealed the presence of collagen Ⅱ in all specimens of Group B, whereas in Group A collagen Ⅱ was found in less specimens. In Group C collagen Ⅱwas not found. CONCLUSION: The matrix, cell distribution, subchondral bone and cartilage mineralization ICRS categories showed statistically differences between the three groups. Group A was second, while group B received the best scores; the control group got the worst ICRS scores in these categories. So, the donor site area, when repairing osteochondral lesions with autografting systems, is better amended with osteochondral autograft rather than bone graft substitute implant.
文摘With advances in biomedical methods, tissue-engineered materials have developed rapidly as an alternative to nerve autografts for the repair of peripheral nerve injuries. However, the materials selected for use in the repair of peripheral nerve injuries, in particular multiple injuries and largegap defects, must be chosen carefully. Various methods and materials for protecting the healthy tissue and repairing peripheral nerve injuries have been described, and each method or material has advantages and disadvantages. Recently, a large amount of research has been focused on tissue-engineered materials for the repair of peripheral nerve injuries. Using the keywords ＂peripheral nerve injury＂, ＂autotransplant＂, ＂nerve graft＂, and ＂biomaterial＂, we retrieved publications using tissue-engineered materials for the repair of peripheral nerve injuries appearing in the Web of Science from 2010 to 2014. The country with the most total publications was the USA. The institutions that were the most productive in this field include Hannover Medical School （Germany）, Washington University （USA）, and Nantong University （China）. The total number of publications using tissue-engineered materials for the repair of peripheral nerve injuries grad- ually increased over time, as did the number of Chinese publications, suggesting that China has made many scientific contributions to this field of research.
文摘BACKGROUND： Autograft is commonly used to repair nerve deficit. Usually, the choice of donor nerves is based on their similarities in form and structures to the injured nerves. For the reason, the cutaneous antebrachii lateralis nerve is currently considered the most suited for digital nerve repair. OBJECTIVE： To compare early nerve regeneration after transplantation of three different autografts： the greater auricular nerve （GAN）, the saphenous nerve （SN） and the lateral femoral cutaneous nerve （LFCN）. DESIGN： Observational contrast study. SETTING： Department of Plastic Surgery and Burns, Tangdu Hospital, Fourth Military Medical University of Chinese PLA. MATERIALS： A total of 42 New Zealand rabbits, of both genders, 12-14 months old and weighing 2.0- 2.5 kg, were used in this study. In addition, Moller-spetra 900 operating microscope （Germany）, Olympus BX 51 microscope, DP 70 image collecting System （Japan）, BL-420E＋ Biologic function testing System （China）, JEM-100 electron microscope （Japan）, Reichet-JunG820 Cryostat （Swiss）, and Libror-AEG-120 precision analytical Balance （Japan） were also used in this study. METHODS： The experiment was carried out in the Department of Plastic Surgery and Burns, Tangdu Hospital, Fourth Military Medical University of Chinese PLA from April to November 2005. After anaesthesia, the GAN were dissected bilaterally and a 1.2 cm deficit was made in each nerve. The animals were randomly divided into three groups, including GAN group, SN group and LFCN group with 14 in each group. ① Nerve pinch test： At 1, 2, and 4 weeks after operation, three animals in each group were tested. The nerve grafts, along with the proximal and distal GAN segments were exposed and pinched with microsurgical forceps in distal-proximal orientations. The distance between the proximal anastomosis site and the most distal point, where the pinch evoked an ear contraction response, was measured as distance of nerve regeneration. ② Computer image analysis： At 4 and 12 weeks, 2 μm sections were prepared, each stained with either HE or methylene blue to assess axon number and density, cross-section area, and myelin sheath thickness. ③ Electrophysidogical tests： At 12 weeks, the bilateral GAN along with the nerve grafts of 4 animals in each group were exposed. Points A, B and C were marked on each specimen： point A： at the proximal GAN segment, 7 cm from the proximal anastomosis; point B： 0.5 cm from the proximal anastomosis; point C： at the distal GAN segment, 0.5 cm from the distal anastomosis. The whole nerve including nerve graft and proximal and distal GAN segments, as a block, was harvested and immersed in Ren＇s solution for several minutes until its excitability was stabilized. The specimen was then placed on the electrodes of the shield box to examine the action potential and conduction velocity on segment AB and AC with BL-420E＋biologic function testing system. AC/AB would be the recovery rate of action potential on segment AC. ④ Horseradish peroxidase （HRP） fascicle： At 12 weeks, at the site on the distal segment of GAN 1.0 cm from the distal anastomosis of nerve graft, the GAN was crushed by a pair of haemostatic forceps and HRP water solution was injected into the nerve. Two rabbits in GAN group, SN group and LFCN group, after having survived for 24 hours, 36 hours and 48 hours were selected. The C2 ganglion was exposed and the distance from C2 ganglion to HRP injection site was taken as the axoplasmic transport distance, from which the axoplasmic transport velocity and the mean density of the labeled C2 ganglion cells were calculated. MAIN OUTCOME MEASURES： ① The greatest distance of nerve regeneration; ② the axon number and density, cross-section area, and myelin sheath thickness; ③ the action potential and conduction velocity; ④ the axoplasmic transport velocity and the mean density of the labeled C2 ganglion cells. RESULTS： All 42 experimental rabbits were involved in the final analysis. ① The greatest distance of nerve regeneration： At 4 weeks after operation, the greatest distance of nerve regeneration was longer in the SN group than that in the GAN group and the LFCN group [（45.17±2.48）, （41.83±2.32）, （34.83±2.64） mm, P 〈 0.05], while the greatest distance of nerve regeneration was longer in the GAN group than that in theLFCN group （P 〈 0.05）. ② The axon number and density, cross-section area, and myelin sheath thickness： The number of nerve fascicle was the greatest in the GAN group, and the cross-section area was the most; however, ratio between nerve fascicle and cross-section area, and the axon density were lower than those in other two groups （P 〈 0.05-0.01）. In contrast, the axon density was the greatest in the SN group. At 4 weeks after operation, axon density was the most in the SN group, and then the GAN group and the LFCN group. There were significant differences among the three groups （P 〈 0.05-0.01）. At 12 weeks after operation, density of myelinated fiber and axon section area were higher in the SN group than those in other two groups （P 〈 0.05-0.01）. ③ The action potential and conduction velocity： At 12 weeks after operation, the maximal action potential, the recovery rate of action potential and the nerve conduction velocity were the highest in the SN group. HRP-labeled neurons early occurred in C2 ganglion, and the action potential and the recovery rate of action potential were increased （P 〉 0.05）. At 12 weeks after operation, even though the maximal action potential, the recovery rate of action potential and the nerve conduction velocity on segment AB remained similar in different groups, on segment AC, the action potential, the recovery rate of action potential and nerve conduction velocity were greater in the SN group than those in other groups. ④ The axoplasmic transport velocity and the mean density of the labeled C2 ganglion cells： After HRP injection in the SN group, the positive labeled cells in C2 ganglion firstly appeared at 24 hours, and in other two groups, they did not appeared until 36 hours. The density of labeled cells was the greatest in the SN group and the lowest in the LFCN group. The axoplasmic transport velocity in the SN group was also significantly faster than in the GAN group and the LFCN group （P 〈 0.05-0.01）. Otherwise, the axoplasmic transport velocity was faster in the SN group than that in the GAN group and the LFCN group. CONCLUSION： The donor nerve with greater axon number and density can achieve much better effects during early regeneration.
文摘BACKGROUND Meniscus extrusion occurs in most elderly individuals and most patients after meniscus allograft transplantation.The risk factors and correlative factors of meniscus extrusion have been extensively studied.However,for using tendon autograft for meniscus reconstruction,both graft type and surgical method are different from those in previous studies on meniscus extrusion.AIM To identify predictive factors for coronal and sagittal graft extrusion length after using tendon autograft for medial meniscus reconstruction.METHODS Ten patients who underwent medial meniscus reconstruction with tendon autograft were selected for this retrospective observational study.The graft extrusions and potential factors were measured and correlation and regression analyses were performed to analyze their relationships.RESULTS The medial graft extrusion correlated with the preoperative bilateral hip-kneeankle angle difference,preoperative Kellgren-Lawrence grade,preoperative relative joint space width,and preoperative bilateral medial edge incline angle difference.The anterior graft correlated with the anterior tunnel edge distance at 1 week after operation.The posterior graft extrusion correlated with the preoperative bilateral hip-knee-ankle angle difference,preoperative relative joint space width,and posterior tunnel edge distance at 1 week after operation.The mean graft extrusion correlated with the preoperative bilateral hip-knee-ankle angle difference and preoperative relative joint space width.The preoperative joint space width and anterior and posterior tunnel edge distance at 1 week can be used to predict the medial,anterior,posterior,and mean graft extrusion length.CONCLUSION The preoperative joint space width and tunnel position can be used to predict the coronal and sagittal graft extrusion length after using tendon autograft for medial meniscus reconstruction.
文摘This letter addresses the recent study by Zhu et al on the predictive factors for coronal and sagittal graft extrusion length following medial meniscus reconstruction using tendon autografts.The study provides valuable insights into the importance of preoperative joint space width and tunnel positioning as predictors of graft extrusion.Specifically,it found strong correlations between preoperative joint space width and medial,posterior,and mean graft extrusion at both 1 week and 8 months post-operation.Additionally,tunnel edge distance at 1 week postoperation correlated with anterior and posterior graft extrusion.These findings offer critical guidance for improving surgical outcomes.However,the letter highlights the need for further research with larger sample sizes and comparative studies involving different graft types to strengthen these findings and broaden their applicability in clinical settings.The study's contributions to understanding meniscus reconstruction using tendon autografts are acknowledged,along with suggestions for future research directions.
文摘Laboratory and clinical experience with PBSCT is reviewed.At.the University of Tokushima,a total of 314 aphoresis were performed by a CS 3000 cell separator in 77 children aged 7 months to 17 years with various types of cancer.Mobidity related to the collection was negligible and a larger number of CFU-GM was collected in younger children than in
基金This work was supported by grants from the National Natural Science Foundation of China （No.81271954,No.81102604）,Shanghai Science and Technology Program （No.12QH1402700）,and the National Basic Research Program of China （No.2009CB930000）.
文摘Background Bone grafting is commonly used to repair bone defects.As the porosity of the graft scaffold increases,bone formation increases,but the strength decreases.Early attempts to engineer materials were not able to resolve this problem.In recent years,nanomaterials have demonstrated the unique ability to improve the material strength and toughness while stimulating new bone formation.In our previous studies,we synthesized a nano-scale material by reinforcing a porous β-tricalcium phosphate （β-TCP） ceramic scaffold with Na2O-MgO-P2O5-CaO bioglass （β-TCP/BG）.However,the in vivo effects of the β-TCP/BG scaffold on bone repair remain unknown.Methods We investigated the efficacy of β-TCP/BG scaffolds compared to autografts in a canine tibioflbula defect model.The tibioflbula defects were created in the right legs of 12 dogs,which were randomly assigned to either the scaffold group or the autograft group （six dogs per group）.Radiographic evaluation was performed at 0,4,8,and 12 weeks post-surgery.The involved tibias were extracted at 12 weeks and were tested to failure via a three-point bending.After the biomechanical analysis,specimens were subsequently processed for scanning electron microscopy analysis and histological evaluations.Results Radiographic evaluation at 12 weeks post-operation revealed many newly formed osseous calluses and bony unions in both groups.Both the maximum force and break force in the scaffold group （n=6） were comparable to those in the autograft group （n=6,P ＞0.05）,suggesting that the tissue-engineered bone repair achieved similar biomechanical properties to autograft bone repair.At 12 weeks post-operation,obvious new bone and blood vessel formations were observed in the artificial bone of the experimental group.Conclusions The results demonstrated that new bone formation and high bone strength were achieved in the β-TCP/ BG scaffold group,and suggested that the β-TCP/BG scaffold could be used as a synthetic alternative to autografts for the repair of bone defects.
文摘Limbal stem cell deficiency(LSCD)causes severe vision impairment and can lead to blindness,representing one of the most challenging ocular surface disorders.Stem cell deficiency can be congenital or,more often,acquired.The categorization of ocular surface transplantation techniques is crucial to achieving treatment homogeneity and quality of care,according to the anatomic source of the tissue being transplanted,genetic source,autologous or allogenic transplantation(to reflect histocompatibility in the latter group),and cell culture and tissue engineering techniques.The aim of this minireview is to provide a summary of the management of LSCD,from clinical characteristics and therapeutic outcomes to the development of novel therapeutic approaches.The manuscript also briefly summarizes recent findings in the current literature and outlines the future challenges to overcome in the management of the major types of ocular surface failure.
文摘Treatment of peripheral nerve injuries remains a challenge to modern medicine due to the com-plexity of the neurobiological nerve regenerating process. There is a greater challenge when the transected nerve ends are not amenable to primary end-to-end tensionless neurorraphy. When facing a segmental nerve defect, great effort has been made to develop an alternative to the au-tologous nerve graft in order to circumvent morbidity at donor site, such as neuroma formation, scarring and permanent loss of function. Tubolization techniques have been developed to bridge nerve gaps and have been extensively studied in numerous experimental and clinical trials. The use of a conduit intends to act as a vehicle for moderation and modulation of the cellular and molecular ambience for nerve regeneration. Among several conduits, vein tubes were validated for clinical application with improving outcomes over the years. This article aims to address the investigation and treatment of segmental nerve injury and draw the current panorama on the use of vein tubes as an autogenous nerve conduit.
文摘Objective:To study the time-course of the regeneration of GAP-43+ nerve, and the effects of NGF and TrkA on this process. Methods: Adult Wistar rats underwent splenectomy and splenic autotransplantation, or sham-operation. On day 7, 14, 30, 60, 90, 120, and 180 after surgery, the density of GAP-43+ nerve fibers in spleen tissues were measured with the immunohistochemistry followed by computer image analysis. The expressions of GAP-43, NGF and TrkA were determined with in situ hybrdization, and their mRNA levels were detected with RT-PCR and image analysis qualification. Results: (1) The GAP-43+ nerve fibers began their regeneration on 30 d after operation and extended from greater omentum into splenic autotransplants. Density of the nerve fibers gradually became greater and almost normal 180 d after operation. (2) In splenic autografts, the mRNA expression of GAP-43, NGF and TrkA appeared on day 30 after the operation, gradually reached the peak on day 90. Conclusion: The renascent GAP-43+ nerve fibers may come from the greater omentum packaging the splenic autografts and NGF and TrkA can promote the nerval regeneration in the autotransplant spleen tissues.
文摘The gold standard for treating peripheral nerve injuries that have large nerve gaps where the nerves cannot be directly sutured back together because it creates tension on the nerve,is to incorporate an autologous nerve graft.However,even with the incorporation of a nerve graft,generally patients only regain a small portion of function in limbs affected by the injury.Although,there has been some promising results using growth factors to induce more axon growth through the nerve graft,many of these previous therapies are limited in their ability to release growth factors in a sustained manner and tailor them to a desired time frame.The ideal drug delivery platform would deliver growth factors at therapeutic levels for enough time to grow axons the entire length of the nerve graft.We hypothesized that mineral coated microparticles(MCMs)would bind,stabilize and release biologically active glial cell-derived neurotrophic factor(GDNF)and nerve growth factor(NGF)in a sustained manner.Therefore,the objective of this study was to test the ability of MCMs releasing growth factors at the distal end of a 10 mm sciatic nerve graft,to induce axon growth through the nerve graft and restore hind limb function.After sciatic nerve grafting in Lewis rats,the hind limb function was tested weekly by measuring the angle of the ankle at toe lift-off while walking down a track.Twelve weeks after grafting,the grafts were harvested and myelinated axons were analyzed proximal to the graft,in the center of the graft,and distal to the graft.Under physiological conditions in vitro,the MCMs delivered a burst release of NGF and GDNF for 3 days followed by a sustained release for at least 22 days.In vivo,MCMs releasing NGF and GDNF at the distal end of sciatic nerve grafts resulted in significantly more myelinated axons extending distal to the graft when compared to rats that received nerve grafts without growth factor treatment.The rats with nerve grafts incorporated with MCMs releasing NGF and GDNF also showed significant improvement in hind limb function starting at 7 weeks postoperatively and continuing through 12 weeks postoperatively when compared to rats that received nerve grafts without growth factor treatment.In conclusion,MCMs released biologically active NGF and GDNF in a sustained manner,which significantly enhanced axon growth resulting in a significant improvement of hind limb function in rats.The animal experiments were approved by University of Wisconsin-Madison Animal Care and Use Committee(ACUC,protocol#M5958)on January 3,2018.
文摘Osteochondral lesions of the talus(OLT) occur in up to 70% of acute ankle sprains and fractures. OLT have become increasingly recognized with the advancements in cartilage-sensitive diagnostic imaging modalities. Although OLT may be treated nonoperatively, a number of surgical techniques have been described for patients whom surgery is indicated. Traditionally, treatment of symptomatic OLT have included either reparative procedures, such as bone marrow stimulation(BMS), or replacement procedures, such as autologous osteochondral transplantation(AOT). Reparative procedures are generally indicated for OLT < 150 mm^2 in area. Replacement strategies are used for large lesions or after failed primary repair procedures. Although shortand medium-term results have been reported, longterm studies on OLT treatment strategies are lacking. Biological augmentation including platelet-rich plasma and concentrated bone marrow aspirate is becoming increasingly popular for the treatment of OLT to enhance the biological environment during healing. In this review, we describe the most up-to-date clinical evidence of surgical outcomes, as well as both the mechanical and biological concerns associated with BMS and AOT. In addition, we will review the recent evidence for biological adjunct therapies that aim to improve outcomes and longevity of both BMS and AOT procedures.
文摘There is much literature about differing grafts used in anterior cruciate ligament(ACL) reconstruction. Much of this is of poor quality and of a low evidence base. We review and summarise the literature looking at the four main classes of grafts used in ACL reconstruction; bone-patella tendon-bone, hamstrings, allograft and synthetic grafts. Each graft has the evidence for its use reviewed and then compared, where possible, to the others. We conclude that although there is no clear "best" graft, there are clear differences between the differing graft choices. Surgeon's need to be aware of the evidence behind these differences, in order to have appropriate discussions with their patients, so as to come to an informed choice of graft type to best suit each individual patient and their requirements.
基金Supported by Biomedical Research Institute grant, Kyungpook National University Hospital at 2013
文摘AIM: To find the risk factors related to the reproliferation of the pterygial tissue after excision and graft surgery.METHODS: Charts of 130 eyes of 130 patients who had pterygial excision from March 2006 to April 2011 were reviewed. Preoperative pterygium morphology, surgical methods, and adjunctive treatments were statistically analyzed for their relationship with recurrence.RESULTS: During the follow-up period, recurrence was observed in 20 eyes(15.4%). None of the preoperative morphologic features were affected the rate of the recurrence. However, an age 【40y [P =0.085, odds ratio(OR) 3.609, 95% confidence interval(CI) 0.838-15.540]and amniotic membrane graft instead of conjunctival autograft(P =0.002, OR 9.093, 95% CI 2.316-35.698) were statistically significant risk factors for recurrence.Multivariate analysis revealed that intraoperative mitomycin C(MMC)(P =0.072, OR 0.298, 95% CI 0.080-1.115)decreased the rate of recurrence. CONCLUSION: Younger age is a risk factor for reproliferation of pterygial tissue after excision and amniotic membrane transplantation(AMT) are less effective in preventing recurrence of pterygium after excision based on the comparison between conjunctival autograft and AMT. Intraoperative MMC application and conjunctival autograft reduce recurrence.
基金Supported by Natural Science Foundation of Jiangsu Province(No.BK20141346)Nanjing Science and Technology Development Plan(No.201402001)
文摘AIM： To compare long-term outcome of primary and recurrent pterygium surgery with three different techniques： combined conjunctival autograft and overlay amniotic membrane transplantation （CAT with AMT）, conjunctival autograft transplantation （CAT） alone and amniotic membrane transplantation （AMT） alone. METHODS： In this retrospective study, 142 eyes of 142 pterygium patients （104 primary, 38 recurrent）who underwent CAT （group A）, AMT （group B） or CAT with AMT （group C） respectively following surgical excision were reviewed and compared based on the recurrences and post-operative complications. RESULTS： The number of recurrence post-surgery were 17 （9 from primary, 8 from recurrent; the same description below）, 18 （10, 8） and 2 （1, 1） in groups A, B, and C respectively; dry eyes were 22 （16, 6）, 27 （18, 9） and 7 （3, 4）; conjunctival inflammations were 30 （17, 13）, 27 （16, 11） and 11 （6, 5）. Patients in group C （either pdmary or recurrent or both） mainly showed significantly better results than those in group A or B （P〈0.05） regarding above-mentioned clinical effects. CONCLUSION： Combined CAT and overly AMT have significantly lower rates of recurrence and postoperative complications for primary and recurrent pterygium surgery than CAT or AMT alone.
基金supported by the Science and Technology Development Plan Project Fund of Jilin Province in China,No.20110492
文摘We hypothesized that a chemically extracted acellular allogeneic nerve graft used in combination with bone marrow mesenchymal stem cell transplantation would be an effective treatment for long-segment sciatic nerve defects.To test this,we established rabbit models of 30 mm sciatic nerve defects,and treated them using either an autograft or a chemically decellularized allogeneic nerve graft with or without simultaneous transplantation of bone marrow mesenchymal stem cells.We compared the tensile properties,electrophysiological function and morphology of the damaged nerve in each group.Sciatic nerves repaired by the allogeneic nerve graft combined with stem cell transplantation showed better recovery than those repaired by the acellular allogeneic nerve graft alone,and produced similar results to those observed with the autograft.These findings confirm that a chemically extracted acellular allogeneic nerve graft combined with transplantation of bone marrow mesenchymal stem cells is an effective method of repairing long-segment sciatic nerve defects.
文摘Current Neuroscience dogma holds that transections or ablations of a segment of peripheral nerves produce： （1） Immediate loss of axonal continuity, sensory signaling, and motor control; （2） Wallerian rapid （1-3 days） degeneration of severed distal axons, muscle atrophy, and poor behavioral recovery after many months （if ever, after ablations） by slowly-regenerating （1 mm/d）, proximal-stump outgrowths that must specifically reinnervate denervated targets; （3） Poor acceptance of microsutured nerve allografts, even if tissue-matched and immune-suppressed. Repair of transections/ablations by neurorrhaphy and well-specified-sequences of PEG-fusion solutions （one containing polyethylene glycol, PEG） successfully address these problems. However, conundrums and confusions regarding unorthodox and dramatic results of PEG-fusion repair in animal model systems often lead to misunderstandings. For example, （1） Axonal continuity and signaling is re-established within minutes by non-specifically PEG-fusing （connecting） severed motor and sensory axons across each lesion site, but remarkable behavioral recovery to near-unoperated levels takes several weeks; （2） Many distal stumps of inappropriately-reconnected, PEG-fused axons do not ever （Wallerian） degenerate and continuously innervate muscle fibers that undergo much less atrophy than otherwise-denervated muscle fibers; （3） Host rats do not reject PEG-fused donor nerve allografts in a non-immuno-privileged environment with no tissue matching or immunosuppression; （4） PEG fuses apposed open axonal ends or seals each shut （thereby preventing PEG-fusion）, depending on the experimental protocol; （5） PEG-fusion protocols produce similar results in animal model systems and early human case studies. Hence, iconoclastic PEG-fusion data appropriately understood might provoke a re-thinking of some Neuroscience dogma and a paradigm shift in clinical treatment of peripheral nerve injuries.
文摘Bone defects may impede normal biomechanics and the structural stability of bone as an organ. In many cases, the correction of bone defects requires extensive surgical intervention involving the use of bone-grafting techniques and other procedures in which healing is slow, there is a high risk of infection and considerable pain is provoked- with no guarantee of complete correction of the defect. Therefore, the search for surgical alternatives continues to present a major challenge in orthopaedic traumatology. The reamer-irrigator-aspirator(RIA) system, which was devised to avoid the problems that can arise with autograft harvesting from the iliac crest, consists of collecting the product of the femoral canal after reaming. The RIA technique improves osteogenic differentiation of mesenchymal stem cells, compared to bone marrow aspiration or cancellous bone harvesting from the iliac crest using a spoon. Another approach, the Masquelet technique, consists of reconstructing a long bone defect by means of an induced membrane grown onto an acrylic cement rod inserted to fill the defect; in a second surgical step, once the membrane is constituted, the cement rod is removed and cancellous autograft is used to fill the defect. Both in RIA and in the Masquelet technique, osteosynthesis is usually needed. Bone transportation by compression-distraction lengthening principles is commonly implemented for the treatment of large bone loss. However, complications are frequently encountered with these techniques. Among new techniques that have been proposed to address the problem of large bone loss, the application of stem cells in conjunction with tissue engineering techniques is very promising, as is the creation of personalised medicine(or precision medicine), in which molecular profiling technologies are used to tailor the therapeutic strategy, to ensure the right method is applied for the right person at the right time, after determining the predisposition to disease among the general population. All of the above techniques for addressing bone defects are discussed in this paper.
基金this study was supported by National Natural Science Foundation of China (No.81672166).
文摘The main purpose of this study patients undergoing a single bundle anterior was to compare the clinical outcomes of cruciate ligament reconstruction (ACL-R) of using quadrupled hamstring (4HT)autografts and two-strand tibialis anterior (2TA) aUografts,and to find out the rate of graft failure and possible causes.We hypothesized that there would be no difference in the clinical outcome,and graft failure would be associated with the use of small sized allograft in young active males with high demand of sports activities.We retrospectively evaluated 222 patients (male,n=167,female,n=55) undergoing ACL-R between January 2010 and July 2014.Of 222 patients,115 were included in the 4HT autograft group and 107 patients in the 2TA allograft group.Inclusion criteria were primary unilateral ACL-R with a minor MCL (<grade Ⅱ)injury with or without meniscus tear and had at least 2.5 years of follow-up.Subjective evaluation was performed using Tegner-Lysholm score,modified Cincinnati knee score,and IKDC knee form.Anteroposterior laxity was assessed using ADT and Lachman test whereas rotational laxity was assessed using pivot shift test.Similarly,functional assessment was performed using range of motion (ROM),Daniel's one-leg hop test,and overall IKDC score.Clinical outcomes were satisfactory and comparable in both groups with no statistically significant difference in all the respective parameters.No statistically significant difference was observed in graft re-rupture rate.However,most graft failures occurred in young active males with high demand of sports activities,graft size smaller than 8 mm,and use of allograft.An autograft with at least 8 mm diameter should be considered in a young active male with high demand of sports activities to avoid graft failure.
