Mesenchymal stem cells(MSCs),distributed in many tissues in the human body,are multipotent cells capable of differentiating in specific directions.It is usually considered that the differentiation process of MSCs depe...Mesenchymal stem cells(MSCs),distributed in many tissues in the human body,are multipotent cells capable of differentiating in specific directions.It is usually considered that the differentiation process of MSCs depends on specialized external stimulating factors,including cell signaling pathways,cytokines,and other physical stimuli.Recent findings have revealed other underrated roles in the differentiation process of MSCs,such as material morphology and exosomes.Although relevant achievements have substantially advanced the applicability of MSCs,some of these regulatory mechanisms still need to be better understood.Moreover,limitations such as long-term survival in vivo hinder the clinical application of MSCs therapy.This review article summarizes current knowledge regarding the differentiation patterns of MSCs under specific stimulating factors.展开更多
BACKGROUND In the field of minimally invasive surgery(MIS)for the treatment of hallux valgus(HV),different techniques have begun to emerge in the literature concerning the distal osteotomy of the first metatarsal bone...BACKGROUND In the field of minimally invasive surgery(MIS)for the treatment of hallux valgus(HV),different techniques have begun to emerge in the literature concerning the distal osteotomy of the first metatarsal bone,the synthesis or not of the metatarsal head,the possible association with lateral soft tissues release(LSTR)and osteotomy of the base of the first phalanx.AIM To evaluate the role of LSTR on percutaneous HV correction,evaluating functional and radiographical results.METHODS From January 2012 to May 2016 a total of 396 patients with mild to moderate symptomatic HV treated with the MIS technique were included in this retrospective study.The technique provides no internal fixation(WOS).Patients were divided into the LSTR group and no LSTR group(LSTR N).This surgical procedure(LSTR)was reserved for insufficient HV angle(HVA)correction during fluoroscopic control.Patients were evaluated at each follow-up by two other authors after appropriate training by senior authors(first practitioners).Clinical evaluation was performed before surgery,6 mo after surgery,and 48 mo follow-up.American Orthopaedic Foot and Ankle Society(AOFAS)and visual analog scale(VAS)score was used to evaluate pain and function,and complications were recorded.In addition,the incidence of relapses and the degree of joint range of motion(ROM)with the association with the LSTR(capsule,adductor tendon,phalanx-sesamoid ligament,and the deep transverse metatarsal ligament)were evaluated.Radiological parameters included HVA and intermetatarsal angle(IMA).Patient satisfaction was assessed.Student t-test and Fisher exact test were used to assess statistical analysis.RESULTS From our study it is clear that no differences in term of HVA,VAS,IMA correction,rate of complications,and AOFAS score were found between groups,while a significant improvement of the same variables was found in each group between pre and postoperative values.A significant improvement in ROM at 6 mo(P=0.018)and 48 mo(P=0.02)of follow-up was found in LSTR N group.Complications were rare in both groups.CONCLUSION LSTR procedure on percutaneous HV correction seems to increase postoperative joint stiffness with a comparable incidence of relapse and a low incidence of complications.展开更多
AIM: To identify the rate of non-responders to clopidogrel treatment in hip fracture patients and study how non-responders differ from controls.METHODS: In a retrospective case-control study we included 28 cases of ac...AIM: To identify the rate of non-responders to clopidogrel treatment in hip fracture patients and study how non-responders differ from controls.METHODS: In a retrospective case-control study we included 28 cases of acute proximal femoral fracture with clopidogrel treatment 2011 to 2013. Eighty-four controls from the same time period were included. Data collected included response to clopidogrel measured with multiple electrode aggregometry(MEA), intraoperative bleeding, erythrocyte transfusion, time to surgery and the incidence of adverse events up to 3 mo after surgery. RESULTS: Eight(29%) of the 28 cases were nonresponders. The median intraoperative bleeding was 300 mL(range, 0-1500), and was lower for non-responders(50 m L) but did not reach statistical significance. Erythrocyte transfusions did not differ between responders, non-responders and controls. Forty-five(40%) of 112 patients had adverse events postoperatively but the rate did not differ between patients with and without clopidogrel treatment.CONCLUSION: Almost one-third of patients withclopidogrel treatment and an acute proximal femoral fracture are non-responders to antiplatelet therapy and can be operated without delay.展开更多
AIM:To evaluate the hospitalization rate of femoralneck fractures in the elderly Italian population over ten years.METHODS:We analyzed national hospitalizations records collected at central level by the Ministry of He...AIM:To evaluate the hospitalization rate of femoralneck fractures in the elderly Italian population over ten years.METHODS:We analyzed national hospitalizations records collected at central level by the Ministry of Health from 2000 to 2009.Age-and sex-specific rates of fractures occurred at femoral neck in people≥65 years old.We performed a sub-analysis over a three-year period(2007-2009),presenting data per five-year age groups,in order to evaluate the incidence of the hip fracture in the oldest population.RESULTS:We estimated a total of 839008 hospitalizations due to femoral neck fractures between 2000 and2009 in people≥65,with an overall increase of 29.8%over 10 years.The incidence per 10000 inhabitants remarkably increased in people≥75,passing from158.5 to 166.8(+5.2%)and from 72.6 to 77.5(+6.8%)over the ten-year period in women and men,respectively.The oldest age group(people>85 years old)accounted for more than 42%of total hospital admissions in 2009(n=39000),despite representing only 2.5%of the Italian population.Particularly,women aged>85accounted for 30.8%of total fractures,although they represented just 1.8%of the general population.The results of this analysis indicate that the incidence of hip fractures progressively increased from 2000 to 2009,but a reduction can be observed for the first time in women≤75(-7.9%between 2004 and 2009).CONCLUSION:Incidence of hip fractures in Italy are continuously increasing,although women aged 65-74years old started showing a decreasing trend.展开更多
BACKGROUND Rotator cuff(RC)tears are one of the most frequent pathologies within the shoulder girdle.Hand dominance and older age are associated with RC tears.Two different surgical procedures,the mini-open(MO)and all...BACKGROUND Rotator cuff(RC)tears are one of the most frequent pathologies within the shoulder girdle.Hand dominance and older age are associated with RC tears.Two different surgical procedures,the mini-open(MO)and all-arthroscopic(AA)approach,represented the standard of treatment.AIM To compare the clinical and biomechanical outcomes of two surgical techniques(AA vs MO procedure)performed to address the painful shoulder syndrome with partial or total supraspinatus tendon tear.METHODS Eighty-eight participants,50 following RC repair with AA and 38 with MO approach,were recruited in the present cross-sectional case-control study(ORTHO-SHOULDER,Prot.0054602).All patients underwent postoperative clinical evaluation for pain(Visual analogic scale),impairment,and disability(disability of the arm,shoulder,and hand)and limitation in daily activity(Constant-Murley score).Patients’shoulder mobility was also assessed in our Laboratory of Functional Movement through a wearable inertial sensor and surface electromyography to monitor kinematics and muscle activity during the movement on the frontal(abduction/adduction)and sagittal(flexion-extension)planes.RESULTS No statistically significant differences between the two procedures were observed in either main clinical score or range of motion.A significant increase in velocity during the movement execution and a higher contribution of upper trapezius muscles were found in the AA group compared with MO patients.CONCLUSION In terms of clinical scores,our findings were in line with previous results.However,the use of technology-based assessment of shoulder mobility has revealed significant differences between the two techniques in terms of mean velocity and pattern of muscle activation.展开更多
Since 1976,the authors began to carry outclinical research work on the treatment of blooddisorders(hypertension and hypotension)due tocervico-spinal diseases with the rotation-reductionmethod.A preliminary analysis an...Since 1976,the authors began to carry outclinical research work on the treatment of blooddisorders(hypertension and hypotension)due tocervico-spinal diseases with the rotation-reductionmethod.A preliminary analysis and summarywere made,and the achievements of this scien-tific research passed technological appraisal inJune,1983.In recent years,the authors havemade an observation of the long-term effect of thetreatment of cervico-spinal hypertension with thismethod,with satisfactory results,which will bereported as follows.展开更多
Diabetes mellitus has become a global health problem,and the number of patients with diabetic foot ulcers(DFU)is rapidly increasing.Currently,DFU still poses great challenges to physicians,as the treatment is complex,...Diabetes mellitus has become a global health problem,and the number of patients with diabetic foot ulcers(DFU)is rapidly increasing.Currently,DFU still poses great challenges to physicians,as the treatment is complex,with high risks of infection,recurrence,limb amputation,and even death.Therefore,a comprehensive understanding of DFU pathogenesis is of great importance.In this review,we summarized recent findings regarding the DFU development from the perspective of single-nucleotide variations(SNVs).Studies have shown that SNVs located in the genes encoding C-reactive protein,interleukin-6,tumor necrosis factor-alpha,stromal cell-derived factor-1,vascular endothelial growth factor,nuclear factor erythroid-2-related factor 2,sirtuin 1,intercellular adhesion molecule 1,monocyte chemoattractant protein-1,endothelial nitric oxide synthase,heat shock protein 70,hypoxia inducible factor 1 alpha,lysyl oxidase,intelectin 1,mitogen-activated protein kinase 14,toll-like receptors,osteoprotegerin,vitamin D receptor,and fibrinogen may be associated with the development of DFU.However,considering the limitations of the present investigations,future multi-center studies with larger sample sizes,as well as in-depth mechanistic research are warranted.展开更多
Musculoskeletal disorders are the leading causes of disability and result in reduced quality of life.The neuro-osteogenic network is one of the most promising fields in orthopaedic research.Neuropeptide Y(NPY)system h...Musculoskeletal disorders are the leading causes of disability and result in reduced quality of life.The neuro-osteogenic network is one of the most promising fields in orthopaedic research.Neuropeptide Y(NPY)system has been reported to be involved in the regulations of bone metabolism and homeostasis,which also provide feedback to the central NPY system via NPY receptors.Currently,potential roles of peripheral NPY in bone metabolism remain unclear.Growing evidence suggests that NPY can regulate biological actions of bone marrow mesenchymal stem cells,hematopoietic stem cells,endothelial cells,and chondrocytes via a local autocrine or paracrine manner by different NPY receptors.The regulative activities of NPY may be achieved through the plasticity of NPY receptors,and interactions among the targeted cells as well.In general,NPY can influence proliferation,apoptosis,differentiation,migration,mobilization,and cytokine secretion of different types of cells,and play crucial roles in the development of bone delayed/non-union,osteoporosis,and osteoarthritis.Further basic research should clarify detailed mechanisms of action of NPY on stem cells,and clinical investigations are also necessary to comprehensively evaluate potential applications of NPY and its receptor-targeted drugs in management of musculoskeletal disorders.展开更多
Aim: To investigate the long term results of the patients followed till the skeletal maturity and treated with Salter innominate osteotomy. Patients and Methods: 85 hips of 63 patients whom were operated by the same s...Aim: To investigate the long term results of the patients followed till the skeletal maturity and treated with Salter innominate osteotomy. Patients and Methods: 85 hips of 63 patients whom were operated by the same surgeon between the years 1985 and 1991 were evaluated retrospectively. 34 hips of 25 patients who did not have enough follow-up or did not reach skeletal maturity at their last radiographic control were excluded from the study. So, 51 hips of 38 patients were included into our study. Mean age of the patients at the time of operation was 3 years 2 months (1.5 - 11 years), mean follow-up time was 16 years 6 months (10 - 23 years) and mean age at the last control was 19 years 7 months (15 - 27 years). Results: The overall clinical results were favorable (excellent or good) in 48 hips (94.1%) according to the modified McKay clinical evaluation scale. Avascular necrosis was evaluated with the Kalamchi-McEven classification at the last follow up and 45 hips (88.2%) had no avascular necrosis. The radiographic results were assessed by the Severin classification system and 10 hips (19.6%) were stage 1a;10 hips (19.6%) were stage 1b;and 30 hips (58.8%) were stage 2. Upon the analysis of our radiographic results according to Stulberg classification system, we found out that only 2 (3.9%) of our patients were Stulberg stage 5, whereas 36 cases (70.6%) were Stulberg stage 1 and 2 (spherical congruency). According to Croft’s classification of hips for degenerative changes, 36 (70.6%) patients were stage 0;6 (11.8%) patients were stage 1;5 (9.8%) patients were stage 2 and 4 patients (8.7%) were stage 3. Conclusion: When appropriate soft tissue balance is provided, the complications of Salter Innominate Osteotomy are decreased and thus, it provides an excellent functional and radiological result.展开更多
Despite improvements in technique and technology for total knee arthroplasty(TKA),anterior knee pain impacts patient outcomes and satisfaction.Addressing the prosthetic and surgical technique related causes of pain af...Despite improvements in technique and technology for total knee arthroplasty(TKA),anterior knee pain impacts patient outcomes and satisfaction.Addressing the prosthetic and surgical technique related causes of pain after TKA,specifically as it relates to anterior knee pain,can aid surgeons in addressing these issues with their patients.Design features of the femoral and patellar components which have been reported as pain generators include: Improper femoral as well as patellar component sizing or designs that result in patellofemoral stuffing; a shortened trochlear groove distance from the flange to the intercondylar box; and then surgical technique related issues resulting in: Lateral patellar facet syndrome; overstuffed patella/flange combination; asymmetric patellar resurfacing,improper transverse plane component rotation resulting in patellar subluxation/tilt.Any design consideration that allows impingement of extensor mechanism anatomical elements has the possibility of impacting outcome by becoming a pain generator.As the number of TKA procedures continues to increase,it is increasingly critical to develop improved,evidence based prostheses that maximize function and patient satisfaction while minimizing pain and other complications.展开更多
Bone graft substitutes are widely used in the field of orthopedics and are extensively used to promote vertebral fusion. Fusion is the most common technique in spine surgery and is used to treat morbidities and reliev...Bone graft substitutes are widely used in the field of orthopedics and are extensively used to promote vertebral fusion. Fusion is the most common technique in spine surgery and is used to treat morbidities and relieve discomfort. Allograft and autograft bone substitutes are currently the most commonly used bone grafts to promote fusion. These approaches pose limitations and present complications to the patient. Numerous alternative bone graft substitutes are on the market or have been developed and proposed for application. These options have attempted to promote spine fusion by enhancing osteogenic properties. In this review, we reviewed biology of spine fusion and the current advances in biomedical materials and biological strategies for application in surgical spine fusion. Our findings illustrate that, while many bone graft substitutes perform well as bone graft extenders, only osteoinductive proteins(recombinant bone morphogenetic proteins-2 and osteogenic protein-1) provide evidence for use as both bone enhancers and bone substitutes for specific types of spinal fusion. Tissue engineered hydrogels, synthetic polymer composites and viral based gene therapy also holds the potential to be used for spine fusion in future, though warrants further investigation to be used in clinical practice.展开更多
The mechanisms that coordinate the shift from joint homeostasis to osteoarthritis(OA)remain unknown.No pharmacological intervention can currently prevent the progression of osteoarthritis.Accumulating evidence has sho...The mechanisms that coordinate the shift from joint homeostasis to osteoarthritis(OA)remain unknown.No pharmacological intervention can currently prevent the progression of osteoarthritis.Accumulating evidence has shown that subchondral bone deterioration is a primary trigger for overlying cartilage degeneration.We previously found that H-type vessels modulate aberrant subchondral bone formation during the pathogenesis of OA.However,the mechanism responsible for the elevation of H-type vessels in OA is still unclear.Here,we found that PDGFR-βexpression,predominantly in the CD31^(hi)Emcn^(hi) endothelium,was substantially elevated in subchondral bones from OA patients and rodent OA models.A mouse model of OA with deletion of PDGFR-βin endothelial cells(ECs)exhibited fewer H-type vessels,ameliorated subchondral bone deterioration and alleviated overlying cartilage degeneration.Endothelial PDGFR-βpromotes angiogenesis through the formation of the PDGFR-β/talin1/FAK complex.Notably,endothelium-specific inhibition of PDGFR-βby local injection of AAV9 in subchondral bone effectively attenuated the pathogenesis of OA compared with that of the vehicle-treated controls.Based on the results from this study,targeting PDGFR-βis a novel and promising approach for the prevention or early treatment of OA.展开更多
AIM To discusses pharmacological and non-pharmacological therapeutic alternatives for managing knee osteoarthritis in primary care by primary health care nurse practitioners.METHODS A case example is presented, the ev...AIM To discusses pharmacological and non-pharmacological therapeutic alternatives for managing knee osteoarthritis in primary care by primary health care nurse practitioners.METHODS A case example is presented, the evidence-based guideline recommendations of the Osteoarthritis Research Society International and the American Academy of Orthopaedic Surgeons are reviewed, and a plan of care is developed.RESULTS Osteoarthritis is the most common form of arthritis seen in primary care, and it is a major public health issue because the aging population and widespread obesity have drastically increased incidence. Osteoarthritis is clinically associated with escalating chronic pain, physical disability, and decreased quality of life. Early diagnosis of mild osteoarthritis in relatively young patients presents an opportunity for primary health care providers to manage pain, increase quality of life, and decrease risk of disability. CONCLUSION Primary health care providers can implement these recommendations in their own practices to provide care to patients with knee osteoarthritis based on current best evidence.展开更多
Objective:This study aimed to investigate whether perceived stress mediated the relationship between hope and anxiety/depression symptoms among patients with COVID-19 during the epidemic.In addition,the potential mode...Objective:This study aimed to investigate whether perceived stress mediated the relationship between hope and anxiety/depression symptoms among patients with COVID-19 during the epidemic.In addition,the potential moderating effect of coping styles was examined.Methods:From February 26 to March 10,2020,patients with COVID-19 were asked to complete a questionnaire online,which included demographic characteristics,as well as the SCL-90-Anxiety,SCL-90-Depression,Chinese Perceived Stress Scale(CPSS),Herth Hope Index(HHI),and Trait Coping Style Questionnaire(TCSQ).Hierarchical linear regression was performed to explore independent factors of anxiety/depression.A multi-group structural equation modeling with the collected data from patients in the Negative Coping style(NC)group and Positive Coping style(PC)group was used to test the hypothesized mechanism.Results:In total,382 valid questionnaires of patients were obtained,including 96 from NC patients and 286 from PC patients.In the hierarchical linear regression,hope and perceived stress were independent risk factors for both anxiety and depression in the total sample and PC group.However,hope was not independently related to anxiety/depression in the NC group.As hypothesized,the hope of patients had significant and negative indirect effects on both anxiety and depression that were mediated by perceived stress,However,the direct effect from stress on anxiety and depression was stronger for NC patients than for PC patients.Besides,hope had significant direct effects on anxiety/depression in PC patients,but not in NC patients.Conclusion:During the COVID-19 epidemic,perceived stress could mediate the relationship between hope and anxiety/depression symptoms among COVID-19 patients,with coping style moderating this cultivation process.展开更多
The relationship between severe acute respiratory syndrome coronavirus-2(SARS-CoV-2)and host immunity is poorly understood.We performed an extensive analysis of immune responses in 32 patients with severe COVID-19,som...The relationship between severe acute respiratory syndrome coronavirus-2(SARS-CoV-2)and host immunity is poorly understood.We performed an extensive analysis of immune responses in 32 patients with severe COVID-19,some of whom succumbed A control population of healthy subjects was included.Patients with COVID-19 had an altered distribution of peripheral blood lymphocytes,with an increased proportion of mature natural killer(NK)cells and low T-cell numbers.NK cells and CD8^(+)T cells overexpressed T-cellimmunoglobulin and mucin domain-3(TIM-3)and CD69.NK cell exhaustion was attested by increased frequencies of programmed cell death protein 1(PD-1)positive cells and reduced frequencies of natural killer group 2 member D(NKG2D)-,DNAX accessory molecule-1(DNAM-1)-and sialic acid-binding Ig-like lectin 7(Siglec-7)-expressing NK cells,associated with a reduced ability to secrete interferon(IFN)γ.Patients with poor outcome showed a contraction of immature CD56^(bright) and an expansion of mature CD57^(+)F_(CEI)Rlγ^(eng) adaptive NK cells compared to survivors.Increased serum levels of IL-6 were also more frequently identified in deceased patients compared to survivors.Of note,monocytes secreted abundant quantities of IL-6,IL-8,and IL-1β which persisted at lower levels several weeks after recovery with concomitant normalization of CD69,PD-1 and TIM-3 expression and restoration of CD8^(+)T cell numbers.A hyperactivated/exhausted immune response dominate in severe SARS-CoV-2 infection,probably driven by an uncontrolled secretion of inflammatory cytokines by monocytes.These findings unveil a unique immunological profile in COVID-19 patients that will help to design effective stage-specific treatments for this potentially deadly disease.展开更多
Balance improvement could contribute to ankle stability for the prevention of ankle sprains.Functional electrical stimulation(FES)is an effective way of augmenting muscle activity and improving balance.This study inve...Balance improvement could contribute to ankle stability for the prevention of ankle sprains.Functional electrical stimulation(FES)is an effective way of augmenting muscle activity and improving balance.This study investigated the effect of FES of peroneal muscles on single-and double-leg balance.Fifteen healthy females(age=23:1±1:6 years,height=1:63±0:07m,and weight=63:7±9:9 kg)performed single-and double-leg standing balance tests with eyes open and closed before and after 15-minute FES intervention during treadmill running at a comfortable,self-selected pace.FES of peroneal muscles was provided bilaterally,using an Odstock Dropped Foot Stimulator.The total excursion of the centre of pressure(COP)was calculated to assess the standing balance control ability.The total excursion of COP in single-and double-leg stance with eyes open reduced significantly after FES intervention by 14.7%(p<0:001)and 5.9%(p=0:031),respectively.The eyes-closed condition exhibited a 12.7%(p=0:002)reduction in single-leg stance but did not significantly change in double-leg stance(p>0:05).Limb preference did not account for balance postintervention.No significant difference in total excursion of COP was found between preferred and less preferred limbs with both visual conditions(p>0:05).FES of peroneal muscles improved standing balance control with eyes open in double-leg and single-leg stance and with eyes closed in double-leg stance.The improvements in balance control with FES treatment did not vary concerning limb preference.展开更多
Purpose:Olecranon fractures are particularly vulnerable to distraction and subsequent fracture dislocation due to the high tensile forces.Surgical treatment aims at reducing the fracture and restoring the anatomical j...Purpose:Olecranon fractures are particularly vulnerable to distraction and subsequent fracture dislocation due to the high tensile forces.Surgical treatment aims at reducing the fracture and restoring the anatomical joint surface condition,as well as neutralizing the strain inhibiting fracture healing.The XS nail®(Intercus GmbH,Bad Blankenberg,Germany),an intramedullary implant exerting compression across the entire fracture surface,unlike plates,leaves a minimal extra-cortical profile,and can be secured with threaded locking wires,thereby retaining the anatomical reduction without displacement or steps within the articular surface,which was often found in tension band wiring.After encouraging initial results,the long-term outcome was assessed.Methods:This retrospective study evaluated the long-term outcome of patients surgically treated at our trauma center between January 2002 and December 2005 using the XS nail®.Patients over the age of 18 years eligible for the study must have undergone surgery for isolated,recent(less than 14 days)traumatic olecranon fractures,without concomitant injuries to the ipsilateral elbow and forearm.Further exclusion criteria were pseudarthrosis,re-fractures and osteotomy for distal humerus surgery,as well as polytraumatized patients unable to aid in their own recovery.Data were retrospectively gathered by standardised questionnaire and patient records,as well as surgery and anesthesiology reports.Data analysis was performed using Microsoft Office Excel?2016.Results:There were 32 patients,13 males(mean age 49.0 years)and 19 females(mean age 68.9 years)with 11 Schatzkers type D,7 each type A and C,5 type B and 2 type E at an average of 55.2 months,all showing complete consolidation.Of them,6 patients had a loss of range of motion with more than 10°in the sagittal plane,and only 1 patient exceeded 10°reduction of supination.Twenty-five patients reported being pain-free under all circumstances,and all but 2 patients(93.75%)had returned to their previous activity level.The average disabilities of the arm,shoulder and hand score was 21.15(range 0-88.3),and the overall Mayo elbow performance index was 91.87,without complications,such as wound infection,neurovascular impairment or premature hardware removal.Conclusion:Using the XS nail®system,all fracture types can be successfully treated and the rate of complications was lower than that treated by standard methods published in current literature.An excellent functional outcome,high range of motion as well as good retention of reduction without soft tissue irritation makes this a very suitable implant for fractures subject to tension.展开更多
At present,effective fixation and anti-infection implant materials represent the mainstay for the treatment of open fractures.However,external fixation can cause nail tract infections and is ineffective for fixing sma...At present,effective fixation and anti-infection implant materials represent the mainstay for the treatment of open fractures.However,external fixation can cause nail tract infections and is ineffective for fixing small fracture fragments.Moreover,closed reduction and internal fixation during the early stage of injury can lead to potential bone infection,conducive to bone nonunion and delayed healing.Herein,we designed a bone adhesive with anti-infection,osteogenic and bone adhesion fixation properties to promote reduction and fixation of open fractures and subsequent soft tissue repair.It was prepared by the reaction of gelatin(Gel)and oxidized starch(OS)with vancomycin(VAN)-loaded mesoporous bioactive glass nanoparticles(MBGNs)covalently cross-linked with Schiff bases.Characterization and adhesion experiments were conducted to validate the successful preparation of the Gel-OS/VAN@MBGNs(GOVM-gel)adhesive.Meanwhile,in vitro cell experiments demonstrated its good antibacterial effects with the ability to stimulate bone marrow mesenchymal stem cell(BMSCs)proliferation,upregulate the expression of alkaline phosphatase(ALP)and osteogenic proteins(RunX2 and OPN)and enhance the deposition of calcium nodules.Additionally,we established a rat skull fracture model and a subcutaneous infection model.The histological analysis showed that bone adhesive enhanced osteogenesis,and in vivo experiments demonstrated that the number of inflammatory cells and bacteria was significantly reduced.Overall,the adhesive could promote early reduction of fractures and antibacterial and osteogenic effects,providing the foothold for treatment of this patient population.展开更多
Over the years,electroconductive hydrogels(ECHs)have been extensively applied for stimulating nerve regeneration and restoring locomotor function after peripheral nerve injury(PNI)with diabetes,given their favorable m...Over the years,electroconductive hydrogels(ECHs)have been extensively applied for stimulating nerve regeneration and restoring locomotor function after peripheral nerve injury(PNI)with diabetes,given their favorable mechanical and electrical properties identical to endogenous nerve tissue.Nevertheless,PNI causes the loss of locomotor function and inflammatory pain,especially in diabetic patients.It has been established that bone marrow stem cells-derived exosomes(BMSCs-Exos)have analgesic,anti-inflammatory and tissue regeneration properties.Herein,we designed an ECH loaded with BMSCs-Exos(ECH-Exos)electroconductive nerve dressing to treat diabetic PNI to achieve functional recovery and pain relief.Given its potent adhesive and self-healing properties,this laminar dressing is convenient for the treatment of damaged nerve fibers by automatically wrapping around them to form a size-matched tube-like structure,avoiding the cumbersome implantation process.Our in vitro studies showed that ECH-Exos could facilitate the attachment and migration of Schwann cells.Meanwhile,Exos in this system could modulate M2 macrophage polarization via the NF-κB pathway,thereby attenuating inflammatory pain in diabetic PNI.Additionally,ECH-Exos enhanced myelinated axonal regeneration via the MEK/ERK pathway in vitro and in vivo,consequently ameliorating muscle denervation atrophy and further promoting functional restoration.Our findings suggest that the ECH-Exos system has huge prospects for nerve regeneration,functional restoration and pain relief in patients with diabetic PNI.展开更多
文摘Mesenchymal stem cells(MSCs),distributed in many tissues in the human body,are multipotent cells capable of differentiating in specific directions.It is usually considered that the differentiation process of MSCs depends on specialized external stimulating factors,including cell signaling pathways,cytokines,and other physical stimuli.Recent findings have revealed other underrated roles in the differentiation process of MSCs,such as material morphology and exosomes.Although relevant achievements have substantially advanced the applicability of MSCs,some of these regulatory mechanisms still need to be better understood.Moreover,limitations such as long-term survival in vivo hinder the clinical application of MSCs therapy.This review article summarizes current knowledge regarding the differentiation patterns of MSCs under specific stimulating factors.
文摘BACKGROUND In the field of minimally invasive surgery(MIS)for the treatment of hallux valgus(HV),different techniques have begun to emerge in the literature concerning the distal osteotomy of the first metatarsal bone,the synthesis or not of the metatarsal head,the possible association with lateral soft tissues release(LSTR)and osteotomy of the base of the first phalanx.AIM To evaluate the role of LSTR on percutaneous HV correction,evaluating functional and radiographical results.METHODS From January 2012 to May 2016 a total of 396 patients with mild to moderate symptomatic HV treated with the MIS technique were included in this retrospective study.The technique provides no internal fixation(WOS).Patients were divided into the LSTR group and no LSTR group(LSTR N).This surgical procedure(LSTR)was reserved for insufficient HV angle(HVA)correction during fluoroscopic control.Patients were evaluated at each follow-up by two other authors after appropriate training by senior authors(first practitioners).Clinical evaluation was performed before surgery,6 mo after surgery,and 48 mo follow-up.American Orthopaedic Foot and Ankle Society(AOFAS)and visual analog scale(VAS)score was used to evaluate pain and function,and complications were recorded.In addition,the incidence of relapses and the degree of joint range of motion(ROM)with the association with the LSTR(capsule,adductor tendon,phalanx-sesamoid ligament,and the deep transverse metatarsal ligament)were evaluated.Radiological parameters included HVA and intermetatarsal angle(IMA).Patient satisfaction was assessed.Student t-test and Fisher exact test were used to assess statistical analysis.RESULTS From our study it is clear that no differences in term of HVA,VAS,IMA correction,rate of complications,and AOFAS score were found between groups,while a significant improvement of the same variables was found in each group between pre and postoperative values.A significant improvement in ROM at 6 mo(P=0.018)and 48 mo(P=0.02)of follow-up was found in LSTR N group.Complications were rare in both groups.CONCLUSION LSTR procedure on percutaneous HV correction seems to increase postoperative joint stiffness with a comparable incidence of relapse and a low incidence of complications.
文摘AIM: To identify the rate of non-responders to clopidogrel treatment in hip fracture patients and study how non-responders differ from controls.METHODS: In a retrospective case-control study we included 28 cases of acute proximal femoral fracture with clopidogrel treatment 2011 to 2013. Eighty-four controls from the same time period were included. Data collected included response to clopidogrel measured with multiple electrode aggregometry(MEA), intraoperative bleeding, erythrocyte transfusion, time to surgery and the incidence of adverse events up to 3 mo after surgery. RESULTS: Eight(29%) of the 28 cases were nonresponders. The median intraoperative bleeding was 300 mL(range, 0-1500), and was lower for non-responders(50 m L) but did not reach statistical significance. Erythrocyte transfusions did not differ between responders, non-responders and controls. Forty-five(40%) of 112 patients had adverse events postoperatively but the rate did not differ between patients with and without clopidogrel treatment.CONCLUSION: Almost one-third of patients withclopidogrel treatment and an acute proximal femoral fracture are non-responders to antiplatelet therapy and can be operated without delay.
基金Supported by Consulting/speaking by Sanofi-Aventis,AMGEN,Servier,Eli-Lilly,Abiogen to Piscitelli PResearch grant and funding for consulting/speaking by Merck,Sanofi-Aventis,Novartis,Stroder-Servier,Procter and Gamble,Ely Lilly,Roche,Glaxo to Brandi ML and Tarantino U
文摘AIM:To evaluate the hospitalization rate of femoralneck fractures in the elderly Italian population over ten years.METHODS:We analyzed national hospitalizations records collected at central level by the Ministry of Health from 2000 to 2009.Age-and sex-specific rates of fractures occurred at femoral neck in people≥65 years old.We performed a sub-analysis over a three-year period(2007-2009),presenting data per five-year age groups,in order to evaluate the incidence of the hip fracture in the oldest population.RESULTS:We estimated a total of 839008 hospitalizations due to femoral neck fractures between 2000 and2009 in people≥65,with an overall increase of 29.8%over 10 years.The incidence per 10000 inhabitants remarkably increased in people≥75,passing from158.5 to 166.8(+5.2%)and from 72.6 to 77.5(+6.8%)over the ten-year period in women and men,respectively.The oldest age group(people>85 years old)accounted for more than 42%of total hospital admissions in 2009(n=39000),despite representing only 2.5%of the Italian population.Particularly,women aged>85accounted for 30.8%of total fractures,although they represented just 1.8%of the general population.The results of this analysis indicate that the incidence of hip fractures progressively increased from 2000 to 2009,but a reduction can be observed for the first time in women≤75(-7.9%between 2004 and 2009).CONCLUSION:Incidence of hip fractures in Italy are continuously increasing,although women aged 65-74years old started showing a decreasing trend.
文摘BACKGROUND Rotator cuff(RC)tears are one of the most frequent pathologies within the shoulder girdle.Hand dominance and older age are associated with RC tears.Two different surgical procedures,the mini-open(MO)and all-arthroscopic(AA)approach,represented the standard of treatment.AIM To compare the clinical and biomechanical outcomes of two surgical techniques(AA vs MO procedure)performed to address the painful shoulder syndrome with partial or total supraspinatus tendon tear.METHODS Eighty-eight participants,50 following RC repair with AA and 38 with MO approach,were recruited in the present cross-sectional case-control study(ORTHO-SHOULDER,Prot.0054602).All patients underwent postoperative clinical evaluation for pain(Visual analogic scale),impairment,and disability(disability of the arm,shoulder,and hand)and limitation in daily activity(Constant-Murley score).Patients’shoulder mobility was also assessed in our Laboratory of Functional Movement through a wearable inertial sensor and surface electromyography to monitor kinematics and muscle activity during the movement on the frontal(abduction/adduction)and sagittal(flexion-extension)planes.RESULTS No statistically significant differences between the two procedures were observed in either main clinical score or range of motion.A significant increase in velocity during the movement execution and a higher contribution of upper trapezius muscles were found in the AA group compared with MO patients.CONCLUSION In terms of clinical scores,our findings were in line with previous results.However,the use of technology-based assessment of shoulder mobility has revealed significant differences between the two techniques in terms of mean velocity and pattern of muscle activation.
文摘Since 1976,the authors began to carry outclinical research work on the treatment of blooddisorders(hypertension and hypotension)due tocervico-spinal diseases with the rotation-reductionmethod.A preliminary analysis and summarywere made,and the achievements of this scien-tific research passed technological appraisal inJune,1983.In recent years,the authors havemade an observation of the long-term effect of thetreatment of cervico-spinal hypertension with thismethod,with satisfactory results,which will bereported as follows.
基金Supported by National Natural Science Foundation of China,No.82172197Guangdong Basic and Applied Basic Research Foundation,No.2022A1515012385Guangdong Provincial Science and Technology Project,No.2020A0505100039.
文摘Diabetes mellitus has become a global health problem,and the number of patients with diabetic foot ulcers(DFU)is rapidly increasing.Currently,DFU still poses great challenges to physicians,as the treatment is complex,with high risks of infection,recurrence,limb amputation,and even death.Therefore,a comprehensive understanding of DFU pathogenesis is of great importance.In this review,we summarized recent findings regarding the DFU development from the perspective of single-nucleotide variations(SNVs).Studies have shown that SNVs located in the genes encoding C-reactive protein,interleukin-6,tumor necrosis factor-alpha,stromal cell-derived factor-1,vascular endothelial growth factor,nuclear factor erythroid-2-related factor 2,sirtuin 1,intercellular adhesion molecule 1,monocyte chemoattractant protein-1,endothelial nitric oxide synthase,heat shock protein 70,hypoxia inducible factor 1 alpha,lysyl oxidase,intelectin 1,mitogen-activated protein kinase 14,toll-like receptors,osteoprotegerin,vitamin D receptor,and fibrinogen may be associated with the development of DFU.However,considering the limitations of the present investigations,future multi-center studies with larger sample sizes,as well as in-depth mechanistic research are warranted.
基金Supported by the National Natural Science Foundation of China,No.81830079Guangzhou Health Science and Technology Project,No.20191A011116Science and Technology Project of Guangzhou Huadu District,No.18-HDWS-003.
文摘Musculoskeletal disorders are the leading causes of disability and result in reduced quality of life.The neuro-osteogenic network is one of the most promising fields in orthopaedic research.Neuropeptide Y(NPY)system has been reported to be involved in the regulations of bone metabolism and homeostasis,which also provide feedback to the central NPY system via NPY receptors.Currently,potential roles of peripheral NPY in bone metabolism remain unclear.Growing evidence suggests that NPY can regulate biological actions of bone marrow mesenchymal stem cells,hematopoietic stem cells,endothelial cells,and chondrocytes via a local autocrine or paracrine manner by different NPY receptors.The regulative activities of NPY may be achieved through the plasticity of NPY receptors,and interactions among the targeted cells as well.In general,NPY can influence proliferation,apoptosis,differentiation,migration,mobilization,and cytokine secretion of different types of cells,and play crucial roles in the development of bone delayed/non-union,osteoporosis,and osteoarthritis.Further basic research should clarify detailed mechanisms of action of NPY on stem cells,and clinical investigations are also necessary to comprehensively evaluate potential applications of NPY and its receptor-targeted drugs in management of musculoskeletal disorders.
文摘Aim: To investigate the long term results of the patients followed till the skeletal maturity and treated with Salter innominate osteotomy. Patients and Methods: 85 hips of 63 patients whom were operated by the same surgeon between the years 1985 and 1991 were evaluated retrospectively. 34 hips of 25 patients who did not have enough follow-up or did not reach skeletal maturity at their last radiographic control were excluded from the study. So, 51 hips of 38 patients were included into our study. Mean age of the patients at the time of operation was 3 years 2 months (1.5 - 11 years), mean follow-up time was 16 years 6 months (10 - 23 years) and mean age at the last control was 19 years 7 months (15 - 27 years). Results: The overall clinical results were favorable (excellent or good) in 48 hips (94.1%) according to the modified McKay clinical evaluation scale. Avascular necrosis was evaluated with the Kalamchi-McEven classification at the last follow up and 45 hips (88.2%) had no avascular necrosis. The radiographic results were assessed by the Severin classification system and 10 hips (19.6%) were stage 1a;10 hips (19.6%) were stage 1b;and 30 hips (58.8%) were stage 2. Upon the analysis of our radiographic results according to Stulberg classification system, we found out that only 2 (3.9%) of our patients were Stulberg stage 5, whereas 36 cases (70.6%) were Stulberg stage 1 and 2 (spherical congruency). According to Croft’s classification of hips for degenerative changes, 36 (70.6%) patients were stage 0;6 (11.8%) patients were stage 1;5 (9.8%) patients were stage 2 and 4 patients (8.7%) were stage 3. Conclusion: When appropriate soft tissue balance is provided, the complications of Salter Innominate Osteotomy are decreased and thus, it provides an excellent functional and radiological result.
文摘Despite improvements in technique and technology for total knee arthroplasty(TKA),anterior knee pain impacts patient outcomes and satisfaction.Addressing the prosthetic and surgical technique related causes of pain after TKA,specifically as it relates to anterior knee pain,can aid surgeons in addressing these issues with their patients.Design features of the femoral and patellar components which have been reported as pain generators include: Improper femoral as well as patellar component sizing or designs that result in patellofemoral stuffing; a shortened trochlear groove distance from the flange to the intercondylar box; and then surgical technique related issues resulting in: Lateral patellar facet syndrome; overstuffed patella/flange combination; asymmetric patellar resurfacing,improper transverse plane component rotation resulting in patellar subluxation/tilt.Any design consideration that allows impingement of extensor mechanism anatomical elements has the possibility of impacting outcome by becoming a pain generator.As the number of TKA procedures continues to increase,it is increasingly critical to develop improved,evidence based prostheses that maximize function and patient satisfaction while minimizing pain and other complications.
文摘Bone graft substitutes are widely used in the field of orthopedics and are extensively used to promote vertebral fusion. Fusion is the most common technique in spine surgery and is used to treat morbidities and relieve discomfort. Allograft and autograft bone substitutes are currently the most commonly used bone grafts to promote fusion. These approaches pose limitations and present complications to the patient. Numerous alternative bone graft substitutes are on the market or have been developed and proposed for application. These options have attempted to promote spine fusion by enhancing osteogenic properties. In this review, we reviewed biology of spine fusion and the current advances in biomedical materials and biological strategies for application in surgical spine fusion. Our findings illustrate that, while many bone graft substitutes perform well as bone graft extenders, only osteoinductive proteins(recombinant bone morphogenetic proteins-2 and osteogenic protein-1) provide evidence for use as both bone enhancers and bone substitutes for specific types of spinal fusion. Tissue engineered hydrogels, synthetic polymer composites and viral based gene therapy also holds the potential to be used for spine fusion in future, though warrants further investigation to be used in clinical practice.
基金This study was supported by the Natural Science Foundation of Guangdong Province,China(2019A1515011614 to ZC)the Science and Technology Program of Guangzhou(202002030483 to ZC)+2 种基金the National Natural Science Foundation of China(81601942 to ZC and 81830079 to BY)the Outstanding Youths Development Scheme of Southern Medical University(2021YQPY008 to ZC)the National Key R&D Program of China(2019YFA0111900 to CL).
文摘The mechanisms that coordinate the shift from joint homeostasis to osteoarthritis(OA)remain unknown.No pharmacological intervention can currently prevent the progression of osteoarthritis.Accumulating evidence has shown that subchondral bone deterioration is a primary trigger for overlying cartilage degeneration.We previously found that H-type vessels modulate aberrant subchondral bone formation during the pathogenesis of OA.However,the mechanism responsible for the elevation of H-type vessels in OA is still unclear.Here,we found that PDGFR-βexpression,predominantly in the CD31^(hi)Emcn^(hi) endothelium,was substantially elevated in subchondral bones from OA patients and rodent OA models.A mouse model of OA with deletion of PDGFR-βin endothelial cells(ECs)exhibited fewer H-type vessels,ameliorated subchondral bone deterioration and alleviated overlying cartilage degeneration.Endothelial PDGFR-βpromotes angiogenesis through the formation of the PDGFR-β/talin1/FAK complex.Notably,endothelium-specific inhibition of PDGFR-βby local injection of AAV9 in subchondral bone effectively attenuated the pathogenesis of OA compared with that of the vehicle-treated controls.Based on the results from this study,targeting PDGFR-βis a novel and promising approach for the prevention or early treatment of OA.
文摘AIM To discusses pharmacological and non-pharmacological therapeutic alternatives for managing knee osteoarthritis in primary care by primary health care nurse practitioners.METHODS A case example is presented, the evidence-based guideline recommendations of the Osteoarthritis Research Society International and the American Academy of Orthopaedic Surgeons are reviewed, and a plan of care is developed.RESULTS Osteoarthritis is the most common form of arthritis seen in primary care, and it is a major public health issue because the aging population and widespread obesity have drastically increased incidence. Osteoarthritis is clinically associated with escalating chronic pain, physical disability, and decreased quality of life. Early diagnosis of mild osteoarthritis in relatively young patients presents an opportunity for primary health care providers to manage pain, increase quality of life, and decrease risk of disability. CONCLUSION Primary health care providers can implement these recommendations in their own practices to provide care to patients with knee osteoarthritis based on current best evidence.
基金supported by Urgent Projccts of Scientific and Technological Research on COVID-19funded by Hubei Province(No.2020FCA014).
文摘Objective:This study aimed to investigate whether perceived stress mediated the relationship between hope and anxiety/depression symptoms among patients with COVID-19 during the epidemic.In addition,the potential moderating effect of coping styles was examined.Methods:From February 26 to March 10,2020,patients with COVID-19 were asked to complete a questionnaire online,which included demographic characteristics,as well as the SCL-90-Anxiety,SCL-90-Depression,Chinese Perceived Stress Scale(CPSS),Herth Hope Index(HHI),and Trait Coping Style Questionnaire(TCSQ).Hierarchical linear regression was performed to explore independent factors of anxiety/depression.A multi-group structural equation modeling with the collected data from patients in the Negative Coping style(NC)group and Positive Coping style(PC)group was used to test the hypothesized mechanism.Results:In total,382 valid questionnaires of patients were obtained,including 96 from NC patients and 286 from PC patients.In the hierarchical linear regression,hope and perceived stress were independent risk factors for both anxiety and depression in the total sample and PC group.However,hope was not independently related to anxiety/depression in the NC group.As hypothesized,the hope of patients had significant and negative indirect effects on both anxiety and depression that were mediated by perceived stress,However,the direct effect from stress on anxiety and depression was stronger for NC patients than for PC patients.Besides,hope had significant direct effects on anxiety/depression in PC patients,but not in NC patients.Conclusion:During the COVID-19 epidemic,perceived stress could mediate the relationship between hope and anxiety/depression symptoms among COVID-19 patients,with coping style moderating this cultivation process.
基金supported by funds from the Italian Ministry of Health to Fondazione IRCC5 Polidinico San Matteo(RC08056520).
文摘The relationship between severe acute respiratory syndrome coronavirus-2(SARS-CoV-2)and host immunity is poorly understood.We performed an extensive analysis of immune responses in 32 patients with severe COVID-19,some of whom succumbed A control population of healthy subjects was included.Patients with COVID-19 had an altered distribution of peripheral blood lymphocytes,with an increased proportion of mature natural killer(NK)cells and low T-cell numbers.NK cells and CD8^(+)T cells overexpressed T-cellimmunoglobulin and mucin domain-3(TIM-3)and CD69.NK cell exhaustion was attested by increased frequencies of programmed cell death protein 1(PD-1)positive cells and reduced frequencies of natural killer group 2 member D(NKG2D)-,DNAX accessory molecule-1(DNAM-1)-and sialic acid-binding Ig-like lectin 7(Siglec-7)-expressing NK cells,associated with a reduced ability to secrete interferon(IFN)γ.Patients with poor outcome showed a contraction of immature CD56^(bright) and an expansion of mature CD57^(+)F_(CEI)Rlγ^(eng) adaptive NK cells compared to survivors.Increased serum levels of IL-6 were also more frequently identified in deceased patients compared to survivors.Of note,monocytes secreted abundant quantities of IL-6,IL-8,and IL-1β which persisted at lower levels several weeks after recovery with concomitant normalization of CD69,PD-1 and TIM-3 expression and restoration of CD8^(+)T cell numbers.A hyperactivated/exhausted immune response dominate in severe SARS-CoV-2 infection,probably driven by an uncontrolled secretion of inflammatory cytokines by monocytes.These findings unveil a unique immunological profile in COVID-19 patients that will help to design effective stage-specific treatments for this potentially deadly disease.
文摘Balance improvement could contribute to ankle stability for the prevention of ankle sprains.Functional electrical stimulation(FES)is an effective way of augmenting muscle activity and improving balance.This study investigated the effect of FES of peroneal muscles on single-and double-leg balance.Fifteen healthy females(age=23:1±1:6 years,height=1:63±0:07m,and weight=63:7±9:9 kg)performed single-and double-leg standing balance tests with eyes open and closed before and after 15-minute FES intervention during treadmill running at a comfortable,self-selected pace.FES of peroneal muscles was provided bilaterally,using an Odstock Dropped Foot Stimulator.The total excursion of the centre of pressure(COP)was calculated to assess the standing balance control ability.The total excursion of COP in single-and double-leg stance with eyes open reduced significantly after FES intervention by 14.7%(p<0:001)and 5.9%(p=0:031),respectively.The eyes-closed condition exhibited a 12.7%(p=0:002)reduction in single-leg stance but did not significantly change in double-leg stance(p>0:05).Limb preference did not account for balance postintervention.No significant difference in total excursion of COP was found between preferred and less preferred limbs with both visual conditions(p>0:05).FES of peroneal muscles improved standing balance control with eyes open in double-leg and single-leg stance and with eyes closed in double-leg stance.The improvements in balance control with FES treatment did not vary concerning limb preference.
文摘Purpose:Olecranon fractures are particularly vulnerable to distraction and subsequent fracture dislocation due to the high tensile forces.Surgical treatment aims at reducing the fracture and restoring the anatomical joint surface condition,as well as neutralizing the strain inhibiting fracture healing.The XS nail®(Intercus GmbH,Bad Blankenberg,Germany),an intramedullary implant exerting compression across the entire fracture surface,unlike plates,leaves a minimal extra-cortical profile,and can be secured with threaded locking wires,thereby retaining the anatomical reduction without displacement or steps within the articular surface,which was often found in tension band wiring.After encouraging initial results,the long-term outcome was assessed.Methods:This retrospective study evaluated the long-term outcome of patients surgically treated at our trauma center between January 2002 and December 2005 using the XS nail®.Patients over the age of 18 years eligible for the study must have undergone surgery for isolated,recent(less than 14 days)traumatic olecranon fractures,without concomitant injuries to the ipsilateral elbow and forearm.Further exclusion criteria were pseudarthrosis,re-fractures and osteotomy for distal humerus surgery,as well as polytraumatized patients unable to aid in their own recovery.Data were retrospectively gathered by standardised questionnaire and patient records,as well as surgery and anesthesiology reports.Data analysis was performed using Microsoft Office Excel?2016.Results:There were 32 patients,13 males(mean age 49.0 years)and 19 females(mean age 68.9 years)with 11 Schatzkers type D,7 each type A and C,5 type B and 2 type E at an average of 55.2 months,all showing complete consolidation.Of them,6 patients had a loss of range of motion with more than 10°in the sagittal plane,and only 1 patient exceeded 10°reduction of supination.Twenty-five patients reported being pain-free under all circumstances,and all but 2 patients(93.75%)had returned to their previous activity level.The average disabilities of the arm,shoulder and hand score was 21.15(range 0-88.3),and the overall Mayo elbow performance index was 91.87,without complications,such as wound infection,neurovascular impairment or premature hardware removal.Conclusion:Using the XS nail®system,all fracture types can be successfully treated and the rate of complications was lower than that treated by standard methods published in current literature.An excellent functional outcome,high range of motion as well as good retention of reduction without soft tissue irritation makes this a very suitable implant for fractures subject to tension.
基金This work was supported by the Guangzhou Science and Technology Program Key Projects(No.202002020001)Science and Technology Planning Project of Guangdong Province(No.2020A0505100039)+1 种基金Autonomous region science and technology branch Xinjiang project plan(No.2022E02040)Clinical Key Specialty in Ningde City,Fujian Province.
文摘At present,effective fixation and anti-infection implant materials represent the mainstay for the treatment of open fractures.However,external fixation can cause nail tract infections and is ineffective for fixing small fracture fragments.Moreover,closed reduction and internal fixation during the early stage of injury can lead to potential bone infection,conducive to bone nonunion and delayed healing.Herein,we designed a bone adhesive with anti-infection,osteogenic and bone adhesion fixation properties to promote reduction and fixation of open fractures and subsequent soft tissue repair.It was prepared by the reaction of gelatin(Gel)and oxidized starch(OS)with vancomycin(VAN)-loaded mesoporous bioactive glass nanoparticles(MBGNs)covalently cross-linked with Schiff bases.Characterization and adhesion experiments were conducted to validate the successful preparation of the Gel-OS/VAN@MBGNs(GOVM-gel)adhesive.Meanwhile,in vitro cell experiments demonstrated its good antibacterial effects with the ability to stimulate bone marrow mesenchymal stem cell(BMSCs)proliferation,upregulate the expression of alkaline phosphatase(ALP)and osteogenic proteins(RunX2 and OPN)and enhance the deposition of calcium nodules.Additionally,we established a rat skull fracture model and a subcutaneous infection model.The histological analysis showed that bone adhesive enhanced osteogenesis,and in vivo experiments demonstrated that the number of inflammatory cells and bacteria was significantly reduced.Overall,the adhesive could promote early reduction of fractures and antibacterial and osteogenic effects,providing the foothold for treatment of this patient population.
基金supported by the President Foundation of Nanfang Hospital,Southern Medical University(2020C024)the Natural Science Foundation of Fujian Province(2021J011156).
文摘Over the years,electroconductive hydrogels(ECHs)have been extensively applied for stimulating nerve regeneration and restoring locomotor function after peripheral nerve injury(PNI)with diabetes,given their favorable mechanical and electrical properties identical to endogenous nerve tissue.Nevertheless,PNI causes the loss of locomotor function and inflammatory pain,especially in diabetic patients.It has been established that bone marrow stem cells-derived exosomes(BMSCs-Exos)have analgesic,anti-inflammatory and tissue regeneration properties.Herein,we designed an ECH loaded with BMSCs-Exos(ECH-Exos)electroconductive nerve dressing to treat diabetic PNI to achieve functional recovery and pain relief.Given its potent adhesive and self-healing properties,this laminar dressing is convenient for the treatment of damaged nerve fibers by automatically wrapping around them to form a size-matched tube-like structure,avoiding the cumbersome implantation process.Our in vitro studies showed that ECH-Exos could facilitate the attachment and migration of Schwann cells.Meanwhile,Exos in this system could modulate M2 macrophage polarization via the NF-κB pathway,thereby attenuating inflammatory pain in diabetic PNI.Additionally,ECH-Exos enhanced myelinated axonal regeneration via the MEK/ERK pathway in vitro and in vivo,consequently ameliorating muscle denervation atrophy and further promoting functional restoration.Our findings suggest that the ECH-Exos system has huge prospects for nerve regeneration,functional restoration and pain relief in patients with diabetic PNI.
