BACKGROUND:Besides drug therapy, regenerative therapy is now a matter of global interest in treating osteoporosis. Therefore, it is also important to find better candidate cels. OBJECTIVE:To cognize the status of drug therapies for osteoporosis and stem cels as regenerative therapy. METHODS:A computer-based search of PubMed was performed by the first author to retrieve articles relevant to stem cel therapy for osteoporosis published from January 2000 to December 2014. The keywords were osteoporosis, drug therapy, bone regenerative medicine, stem cel therapy, which appeared in the title, abstract or keywords, and the relevant references were also looked up. Articles published recently or in authoritative journals were preferred, and finaly 39 articles were included in result analysis. RESULTS AND CONCLUSION:Yoshikazu Mikami and co-workers from Japan found two novel bone formation accelerators, SST-VEDI and SSH-BMI, which provides a new direction for related studies on drug therapy. Due to the osteogenesis ability, lack of ethical controversy and less damage, de-differentiated fat cels and pulp stem cels may be promising candidate cels for bone regeneration medicine.

BACKGROUND:Bone marrow mesenchymal stem cells are ideal as tissue engineering seed cells, but the proliferation and differentiation of mesenchymal stem cells in vitro is very different at different ages. Moreover, there are few reports on the association between age and the number of bone marrow mesenchymal stem cells. OBJECTIVE:To observe the difference in differentiation ability of bone marrow mesenchymal stem cells from rats at different ages. METHODS:We isolated, purified and amplified the mesenchymal stem cells from rat bone marrow in vitro by the whole bone marrow adherent culture;observed the morphological characteristics of mesenchymal stem cells under an inverted phase contrast microscope;detected cellsurface markers by flow cytometer. Then, mesenchymal stem cells were induced in vitro into osteoblasts and chondroblasts and verified. Passage 3 cells from rats at ages of 2, 4, 6, 8, 12 weeks and 10, 12 months were subjected to osteogenic induction at weeks 1, 2, 3. ELISA was used to determine osteocalcin content. RESULTS AND CONCLUSION:Bone marrow mesenchymal stem cells cultured in vitro were adherent and exhibited a fibroblast-like spindle shape. In vitro, cells proliferated quickly to form colonies. Flow cytometry showed that the cells were positive for CD29, CD90, but negative for CD45, and partial y expressed CD44. After osteogenic induction, cells were positive for alkaline phosphatase staining and alizarin red staining;after chondrogenic induction, cells were positive for alcian blue staining. Mesenchymal stem cells could be isolated and cultured by the method of bone marrow adherent culture in vitro. However, bone marrow mesenchymal stem cells from rats at different ages exhibit decreased proliferation and differentiation abilities with the increase of age through determination of osteocalcin content.

[Objective] To evaluate the histocompatibility of nano hydroxyapatite-zirconia composite bioceramic.[Methods]According to the standard of ISO 10993-1,cytotoxicity experiment,acute toxicity test,hemolysis test and in vivo implantation(90 days)test were conducted to evaluate the histocompatibility of nano hydroxyapatite-zirconia composite bioceramic.[Results]The score of cytotoxicity experiment was lower than grade I,and there was no significant inhibition of cell growth,no acute toxic reaction or hemolytic reaction.And the in vivo implantation met the requirements of the biological evaluation of implant materials.[Conclusion]Nano hydroxyzpatie-zirconia composite bioceramic showed a good histocompatibility.It has a broad prospect as a biomaterial scaffold in the bone tissue engineering.

BACKGROUND: Hydroxyapatite is a kind of ideal orthopedic material, but its Iow strength and brittleness need to improve. The research suggested that the improvement of the toughness and strength of bioceramics which composite hydroxyapatite (HAP) and zirconia (3% mol yttria-stabilized cubic zirconia) and fabricated ceramic scalpel possesses of the wound recover faster with smaller side. So it is significant that research on the incision concrescence of nano-sized hydroxyapatite-zirconia bioceramical scalpel.OBJECTIVE: To observe the effects of incision using nano-sized HAP-TZP bioceramics as scalpel.DESIGN: A single sample study.SETTING: Second Department of Orthopaedics, the Second Affiliated Hospital of Harbin Medical University and Harbin Institute of Technology.MATERIALS: The experiment was carried out in the Animal Laboratory of the Second Affiliated Hospital of Harbin Medical University (Provincial Laboratory) from March to May 2006. A total of 54 SD rats, of 4 months old, weighing 120-180 g, of both genders, were selected in this study. The experiment materials included nano-sized hydroxyapatite Quartz Clock Company), ammonia (Suihua Chemical Reagent Company), and anhydrous ethanol (Tianjin Chemical Reagent Company).METHODS: The nano-sized Hydroxyapatite/zirconia composite powder was synthesis by rubbing according to 40% hydroxyapatite + 60% zirconia powders (mass ratio) were mixed and milled. The knife-edge biomaterials, which fabricated by hot pressed sintering, was grinding and used in incision experiment after autoclaving. The back of the rats was shaved and removing a patch of skin under ether anesthesia made a length of 2 cm open excision wound and stitched up the tear by 1# string. The each 18 rats were sacrificed on 3, 7 and 14 days post-wounding and used for analyses respectively. A full-thickness specimen containing the wound was dissected out from each of the surgical sites. The hematoxylin-eosin (HE) staining was applied in the pathological observation.MAIN OUTCOME MEASURES: The tissue sections of back and the results of pathological observation. RESULTS: All 54 rats were involved in the results analysis without any loss. There was long gap with minimal cellular reaction in the scalpel wounds that has not healed on day 3. There was inflamed cells infiltration at the wounded margin edge. By week 1, the tiny detritus which some of them appear the repaired response of epidermis rend were still obviously found in the area of the scalpel wounds where the detritus was found to be significantly less, the wounds changed smooth and started to heal. The optical microscopy observed indicated that there was incomplete epithelialization and hyalinization of dermal collagen at the wounded area. There were obvious inflamed cells to infiltrate in the margin subcutaneous tissue of the wounds where the newborn loose collagenous fibers filled in scalpel wounds was the tissue repairing response phase. There was a great deal of the infiltrated white blood cells in the subcutaneous tissue. The tiny detritus of epidermis by the optical microscopy observed rend could not be found in the area of the scalpel wounds which were healed by week 2. The newborn capillary nets appeared in the newborn repaired collagen fibers tissue. The inflamed cells to be infiltrated were reduced. The compact and strong collagenous fibers filled in scalpel wounds were the normal wound repairing and tissue. The white blood cells infiltrated obvious reduction in the subcutaneous tissue. The normal blood cells in the newborn capillaries could be seen. CONCLUSION: The experiments prove that a HAP-ZTP bioceramic scalpel, which possesses excellent bioactive, is nontoxic, nonallergenic and noncarcinogenic for incisions.

Objective　In order to predict or exclude early ectopic pregnancy.Methods　Endomertrium of 49 early intrauterine and 52 ectopic pregnancy were observed by transvaginal ultrasonography. Trophoblastic artery flow were investigated surrounding the intrauterine embryo or within the endometrium.Results　An endometrial three-line pattern resembled late proliferative endometrium of the normal menstrual cycle were seen in 42 ectopic pregnancy(80.8%). An endometrial three-line pattern were not seen in 49 early intrauterine pregnancy. Thirty-nine early intrauterine pregnancy had trophoblastic artery flow surrounding the intrauterine embryo or within the endometrium. None of ectopic pregnancy had trophoblastic artery flow within the endometrium.Conclusion　Observation of endometrial three-line pattern and trophoblastic artery flow by transvaginal ultrasonography were useful for diagnosing eraly ectopic pregnancy.

BACKGROUND:Mesenchymal stem cells are a kind of adult stem cells with the potentials of self-replicating and multi-directional differentiation. Under certain conditions, the cells can develop into bone, cartilage and other types of cells. Granulocyte colony-stimulating factors can promote regeneration of mesenchymal stem cells.
OBJECTIVE:To observe the osteogenic induction effect of granulocyte colony-stimulating factors by animal experiment, and provide a better treatment method for clinical treatment of bone defect.
METHODS:Forty New Zealand rabbits were randomly divided into treatment group and model group. Al animals were removed 2 cm length of the right radial bone and the surrounding periosteum, and then implanted with demineralized bone matrix into the defect. The treatment group was subcutaneously injected with granulocyte colony-stimulating factor 30μg/kg per day, the injection was started at preoperative 3 days and given for 7 continuous days. In control group, the same dose of physiological saline was injected.
RESULTS AND CONCLUSION:In the treatment group, the number of mesenchymal stem cells, the quantity and quality of bone formation at bone defects were better than those in the model group. The experimental findings indicate that granulocyte colony-stimulating factor can obviously increase the number of mesenchymal stem cells and promote bone formation at the area of bone defect, which can contribute to early repair of bone defects.

Objective To compare the clinical effect of the primary total hip replacement (THR)and the secondary THR after failed internal fixation in elderly patients with displaced femoral neck fracture,so as to investigate the optimal treatment for displaced femoral neck fractures in elderly patients.Methods From January 2006 to December 2012,22 patients treated with a secondary THR after failed internal fixation were chosen as the observation group and 30 patients treated with a primary THR were chosen as the control group,the operation time,blood loss,postoperative Harris scores for hip joint and health-related quality of life (~ index score) were observed and analyzed in two groups.Results Both of the groups were followed up successfully and each of the groups had 1 patient died.There were no joint infection,re-operations and any other complications in both groups.The operation time in observation group was longer than that in control group [(114.82 ±32.13) min vs.(90.63 ± 16.24) min],blood loss was more than that in control group [(551.73 ± 241.62) ml vs.(314.46:± 156.72) ml],there was significant difference (P ＜ 0.05).But the Harris score and KPS index score between two groups had no significant differences (P ＞ 0.05).Conclusion The primary THR in elderly patients with displaced femoral neck fracture has lower risk in operation tocompare with the secondary THR after failed internal fixation,but the two ways are similar in the hip joint function recovery and improve patients quality of life.

BACKGROUND:Studies have shown that bone loss can lead to a series of diseases, such as osteoporotic fractures, thus seeking to increase bone mass has become a goal of the majority of researchers.
OBJECTIVE:To summarize the current studies of improving bone mass by using stem cel transplantation, hoping to the extensive application of stem cel transplantation in the clinical treatment of osteoporosis as early as possible.
METHODS:A computer-based search of PubMed and CNKI was performed by the first author to retrieve articles relevant to stem cel therapy for osteoporosis published from January 1997 to October 2014. The keywords were“to improve bone mass, regenerative medicine, bone marrow mesenchymal stem cel transplantation, stem cel therapy”in Chinese and English, respectively, which appeared in the title, abstract or keywords. Articles published recently or in authoritative journals were preferred, and final y 28 articles were included in result analysis.
RESULTS AND CONCLUSION:Bone marrow mesenchymal stem cel s which are isolated and cultured easily can proliferate rapidly and have multi-lineage differentiation potential. Studies have shown that the osteogenic differentiation of bone marrow mesenchymal stem cel s can real y improve bone mass, and obtain more achievements in the treatment of orthopedic disorders. This new cel therapy can help to accelerate bone healing and reduce treatment time, offering a new therapeutic choice for orthopedic surgery, plastic surgery, oral and maxil ofacial surgery, and therefore, it has broad application prospects.

Objective To compare the biomechanical effect of several commonly used internal fixators in treating the femoral neck fractures so as to provide clinical basis for the selection of ideal internal fixation.Methods Twelve artificial PMMA femoral models were selected,and the central neck of the specimens was sawn with an electric saw at Pauwels angle of 70° to form adduction type femoral neck fracture models.After anatomic reduction,the specimens were fixed with dynamic hip screw ( DHS),three hollow screws,proximal femoral nail (PFN) and dynamic sleeve three-wing screw according to the operative approach,respectively.Instron-8874 servo-hydraulic mechanical testing machine was used to fix the specimens which simulated uniped standing.Fifteen key points on proximal femur were selected as test points and were given gradation loading at speed of 10 mm/min with linear load 0-1 200 N.The strain of each point under 1200 N load,head sink displacement under different loads and the strain of eight points on principal pressure side were measured.Results There was a peak at the eight resistance strain gage at 1200 N load and the strain values of the DHS,three hollow screws,PFN and dynamic sleeve three-wing screw were (700 ±35) μεz,(756 ± 14) με,( 1362 ± 136) με and (3024 ± 127) με,with statistical significance (P ＜ 0.01 ).Under the same load,the head sink displacement in the group of dynamic sleeve three-wing screw was greater than that of the hollow screws group and the PFN group ( P ＜0.01 ),but smaller thau that of the DHS group ( P ＜ 0.01 ).The strain values at the eight resistance strain gage in the group of dynamic sleeve three-wing screw was larger than that of the other three groups under the same load (P ＜ 0.01 ),and the strain values increased with the increase of load at the same fixation group.Conclusion Dynamic sleeve three-wing screw has good biomechanical stability for treatment of femoral neck fracture,which can be applied in the clinical practice.

ObjectiveTo evaluate the clinical outcome of new proximal femoral nail antirotation (PFNA) in treatment of subtrochanteric fractures. MethodsThere were 31 patients with traumatic subtrochanteric fractures intramedullarily fixed with PFNA. The patients included 14 males and 17 fe-males at a mean age of 54.6 years (range 34-90 years). According to Seinsheimer classification of sub-trochanteric fractures, 14 patients were with type Ⅱ fractures (including four patients with type ⅡA,seven with type ⅡB and three with type ⅡC), 12 with type Ⅲ fractures (including eight with type ⅢA and four with type ⅢB), two with type Ⅳ fractures and three with type Ⅴ fractures. Close reduction was performed under traction and C-arm fluoroscopy in 26 patients and open reduction through a mini-incision before inserting the nail in five patients due to difficult close reduction. ResultsThe operation lasted for a mean time of 72.5 minutes (range 45-120 minutes), with mean blood loss of 127.5 ml (range 100-350 ml). Of all, 27 patients (87.1%, 27/31) were followed up for a mean duration of 14.3 months (range 8-24 months), which showed fracture union in all patients, with a mean union period of 17.4 weeks (range 10-21 weeks). According to Harris Hip Rate Scale, the results were. excellent in 21 pa-tients, good in two and fair in four, with excellence rate of 85.2% (23/27). ConclusionsPFNA is an effective device for treatment of subtrochanteric fracture, with a high union rate and a low complication rate, for it has advantages of easy use and minor trauma, low bleeding and stable fixation in operation.