[Objective]To discuss the clinical problems of meniscal transplantation based on 2 cases clinical practical results including the harvest and preserved methods of meniscal allograft,operative procedure,rehabilitation plan and side-effect,combining with literature review,so as to provide reference for further clinical practice and research.[Method]The meniscal allograft were perfumed with arthroscopic technique on 2 patients,younger than 50 years,suffering from severe meniscus tear or defect at the time of other procedures.The initial clinical results about relieving of symptoms,recovery of functions were evaluated after short time rehabilitations.[Result]There was no operative side-injury and signs of knee instability.The incisions healed well without exudation.The knee joint swelling disappeared in 6 weeks.Rejection reaction was not observed in all of laboratory tests.The VAS were 8,6 preoperatively and 3,2 postoperatively.The processes of rehabilitation were normal.[Conclusion]Considering the difficult in maintaining severe tear meniscus and the characteristics of immune evasion of meniscus,meniscal allograft may be expectable option in the future.Very many researches have provided theoretical base.The results of long-time following-up should be further observed and wany clinical problems need to be further solved.

[Objective] To investigate the establishment of the Allograft Menisci Bank so as to provide suitable allograft meniscus for clinical study of allograft meniscus transplantation.[Method]The allograft menisci from the plentiful donors of the tissue bank were achieved and preserved with the deep-frozen technique.Clinical use of allograft menisci should be based on practical requirement of patients and the data recorded in the Menisci Bank.[Result]From 2005 to the end of 2006,an Allograft Menisci Bank was established which consisted with about 300 different-sized menisci and 14 allograft menisci were provided for clinical study.[Conclusion]Establishment of the Allograft Menisci Bank can provide a base for clinical meniscus transplantation.The short-term effects of the allograft menisci transplantation are satisfactory,but the long-term outcomes need more cases and further observation.

D and the differences between groups were statistically significant(P0.05).Proliferation index increased in the early phase and reached the peak at the 4th post-operative week.Level of proliferation index in four groups was gradiently decreased from group A to group D.At the 4th post-operative week,differences of proliferation index were statistically significant between groups(P0.05).The changing trend of ratio of CD4+/CD8+ was similar to that of proliferation index.Histological observations showed inflammatory cells infiltrated in early phase gradiently decreased from group A to group D.At the 4th post-operative week,histological observations showed neovascularization in group D.At the 8 weeks post-operatively,more new bone formation was observed in group D. The correlation analysis showed significant positive correlation between proliferation index,CD4+/CD8+ ratio at the 4th post-operative week and the content of total lipid (P

[Objective]To explore the influence of defatting procedure on osteogenicity of cancellous bone allograft.[Method]Thirty inbred Lewis rats were killed.Distal femoral metaphyses were resected as cancellous bone grafts.Grafts were randomly divided into four groups which were treated by four different procedures,respectively.Content of total lipid and total protein in grafts were measured.Twelve inbred Fisher344 rats were randomly divided into four groups according to different grouped grafts which were transplanted into femoral metaphysis bone defects of the recipients.Two different fluorochrome dyes were given subcutaneously to the recipients at 14th and 4th days before sacrifice respectively.All rats were killed at the 8th postoperative week.The experimental distal femoral metaphyses were harvested and nondecalcified sections were prepared.Sections were observed with a fluorescent microscope and bone histomorphometries were studied.The correlation analysis was performed between mineral apposition rate(MAR) and the content of total lipid.[Result]Results of measurement showed content of total lipid in four grouped grafts were different and the difference between groups were statistically significant(P

Objective To observe the nerve regeneration and functional recov er y in canines, in which a large gap was made in the continuity of the sciatic ner ve and the gap was repaired by acellular allograft through chemical extraction. Methods 15 canines were divided into acellular nerve allografting group (ANG, 6 canines), autografting group (AG, 6 canines) and fresh nerve allografting group (FNG, 3 canines). The sciatic nerves on the right side of all animals were expos ed and 5.0 cm long segments were removed from the mid-thigh level and replaced by one of the three types of grafts. The motor recovery was assessed by gait tes t at month 6 postoperatively. The sensory and motor conducting functions were as sessed by electrophysiological experiments. The nerve regeneration was revealed by morphological studies on the grafting segments, the distal tibial nerves and motor end-plate of the target muscle. Results All the animals in ANG and AG gro ups had similar patterns of right posterior limb gait cycle and right ankle move ments. Stimuli (1.0-2.0 mA, 0.1 ms, 1.0 Hz) to the sciatic nerves proximal to t he implanted segment resulted in motor-evoked potentials recorded from the musc ulus triceps surae. The motor conducting velocities of the grafting segments wer e on average 47.2 m/s in ANG, 60.9 m/s in AG and 122.0m/s in normal controls. St imuli (5.0-10.0 mA, 0.2 ms, 1.9 Hz) to the right distal tibial nerves resulted in sensory-evoked potentials recorded from the cortical area in all the canines in ANG and AG groups. Axons regeneration and Schwann cells migration had reoccu pied the empty basal lamina tubes of the acellular allografting segments without excessive sign of inflammation. ANG and AG had similar nerve regeneration with massive large nerve fibers in the distal tibial nerves and vast motor end-plate in the target muscle. Conclusions The patterns of functional recovery and nerve regeneration tend to be similar 6 months after implantation in the canines, in which a 5.0 cm gap in the continuity of the sciatic nerve is repaired by either chemical acellular nerve allografting or autografting.

Objective To establish an artificial reflex arc to reinnervate the nerropathic bladder and restore bladder function after spinal cord injury. It involves a somatic reflex are with a modified efferent branch which passes the somatic motor impulses to the bladder and initiate autonomic bladder detrusor contraction. Methods This is achieved by intradural microanastomosis of the right L5 ventral root to S2 ventral root in canines. After a-conal regeneration,the pateller ligament-spinal cord center-bladder new artificial bladder reflex pathway was extablished. The early and final function of the reflex are was observed by electrophysiological experiments, bladder pressure tests and detrusor electromyograms (EMG)' Surgical operation of bilateral intradural microanastomosis of the L5 ventral roots to the S2 ventral roots was done in a 20 years old male patient with upper thoracispinal paraplegia. Results Single stmuli (115 mV, 1. 0 ms) of the right L, dorsal root resulted in evoked potentials recorded from the right S2 ventral root distal to the anastomosized site in all 6 canines. In 4 canines 6 months postoperation and 48 hours after spinal cord was transected, bladder contraction was very quickly initiated by trains of stimuli (l 000 mV, 10 Hz, 2 s) of the right L5 dorsal root and bladder pressures increased rapidly to average 65% of normal compared to controls' Bladder contraction induced by knocking the right pateller ligament increased to average 51 % of controls througt the new reflex arc. In 2 canines 18 months postoperation,bladder pressures increased by the same stimuli to average 84% of controls and to average 62% of controls by knocking the pateller ligament. Stimuli (3. 8 mA, 1' 0 Hz) of the right L5 dorsal root and femoral nerve resulted in EMG recorded from the detrusor in 2 canines 18 months postoperation. The patient achieved controllable micturition by calcaneus tendon-spinal cord center-bladder new artificial bladder reflex pathway at 14 months postoperation. Micturition was very quickly initiated by passive dorsalflexion of either lateral ankle joint,and the results of bladder function was excellent at postoperation. Conclusion The somatic motor a-cons can regenerate into the parasympathetic endoneurial tubes of autonomic nerve. Using the survived somatic reflex under the horizon of spinal cord injury to reconstruct the bladder autonomic reflex arc by intradural microanasto- mosis of ventral root is successful in the first patient and have a potential of clinical application.

BACKGROUND:Bone marrow mesenchymal stem cells (BMSCs) are a kind of stem cells with multi-directional differentiation ability and play an important role in the healing of fractures. Therefore, it is of great significance to explore how to promote the BMSCs migration in vivo, thereby promoting bone defect repair.OBJECTIVE:To study the effects of different concentrations of musk ketone on in vivo migration of exogenous BMSCs, and to preliminarily explore the mechanism of fracture healing and cited theory.METHODS:A rat model of skull defects was made. Passage 3 BMSCs were harvested by using adherence method,labeled with DAPI, and then injected via the tail vein into the model rats. After that, the rats were intragastrically administrated with 0 (blank control), 42 (low dose), 84 (middle dose), 168 μL/kg (high dose) musk ketone, respectively.RESULTS AND CONCLUSION:The number of exogenous BMSCs in the defect region, and the expression of stem cell factor and Fractalkine showed a significant increase in the low- and middle-dose groups compared with the high-dose and blank control groups. These findings indicate that the low- and middle-dose musk ketone can promote the in vivo migration of exogenous stem cells.

BACKGROUND:Core decompression and autogenous bone grafts are widely used in treatment of early avascular necrosis of femoral head. According to the report, the success rate of this therapy has obvious difference;the reasons may be related to inaccurate puncture location and secondary damnification of repeated puncture. OBJECTIVE:To reconstruct three-dimensional model of femoral head necrosis by Mimics software for reappearance of lesions in the necrotic area to realize measurement of necrotic area of the femoral head and estimation of its volume. METHODS:We restructured images by using multi-slice spiral CT Syngommvvp VE23A workstation, Inspace software and NeuroDSA software. Hip CT data in DICOM format were imported into Mimics 13.0 software systems. Necrotic area of the femoral head was reconstructed with Mimics SimuIation software to truly reproduce the integrated form, scope and stereochemical structure of the necrotic area so as to achieve the measurement of the necrotic area of the femoral head and the volume estimation. We designed the best core decompression channel, simulated core decompression surgery, so that the patients could refer to the best simulated decompression path in the operation of core decompression. RESULTS AND CONCLUSION:(1) Among 36 patients (48 hips) with avascular necrosis of femoral head, there were phase I in 8 hips, accounting for 17%, phase II in 28 hips, accounting for 58%, and phase III in 12 hips, accounting for 25%. (2) The volume of necrotic area was (1 475.48±647.342) mm3 in the phase I, (4 571.77±2 344.55) mm3 in the phase II, and (4 836.46±2 969.33) mm3 in the phase III. (3) We simulated the core decompression based on the radius of the sphere of the necrotic area as parameter in the Mimics Simulation software module, and then completely cleared the necrotic area. (4) Surgery can more clearly understand information and stereochemical structure of the necrotic area with Mimics software to simulate the core decompression. It is the theoretical basis of operation.

Objective To observe the effect of the average heart rate (HR) and the variability of HR on image quality of 3D free-breathing whole-heart coronary MR angiography (MRCA). Methods A total of 65 healthy volunteers underwent retrospectively electrocardiography-gated 3D free-breathing whole-heart coronary MRA with ECG-gated 3D segmented-k-space gradient echo sequence. Two observers evaluated image quality of each coronary segment. Visualization of the proximal coronary arteries (CA) with coronary MRA was qualitatively evaluated using a four point grading scale (1: excellent; 2: good; 3: moderate; 4: non-diagnostic). Pearson correlation analysis was performed to analyze the correlation between image quality of each coronary artery and the average HR and heart rate variability. Results Average HR was 64.5±13.3 beats per minute (bpm) (range 40-86 bpm) with a variability of (6.1%±2.6)%. No significant correlation presented between mean HR and image quality of all segments of the left circumflex and left anterior descending artery except the right coronary artery (P<0.05). heart rate variability significantly correlated with overall image quality (P<0.001) and image quality of each coronary artery. Conclusion heart rate variability influences the image quality of 3D free-breathing coronary MRA more obvious than HR does.

Objective To provide immunological evidence for clinical transfer of chemical extracted acellular nerve allografL Methods One hundred and twenty-eight BALB/C mice were randomly divided into 4 groups of equal size according to their different treatments:negative contrast group(NC),fresh autograft group(AG),fresh allogeneic nerve group(FN)and chemical extracted aceflular allogeneic nerve group(CEN).Then we implanted various kinds of nerve grafts into the thigh muscle of BALB/C mice in corresponding groups.At 3,7,14,28 days postoperatively,8 mice from each group were killed each time to harvest their spleens,from which T lymphocytes were collected.Theu monoclonal antibodies(CD3,CD4 CD8 CD25,IL-2,IFN-γ, TNF-α)were added into the suspension.Then fluorescence.activated cell sorting(FACS)was used to determine the positive rates of cells combined with the above monoclonal antibodies. Results There were no statistically significant differences between CEN group,NC group,and AG group,but indexes of FN group were significantly higher than those of the other 3 groups at corresponding time points. Conclusion There is no obvious immune reiection of chemical extracted acellular nerve allograft when compared with fresh nerve autograft.