OBJECTIVETo investigate the effectiveness of injectable tissue engineering to repair full-thickness meniscal defects.

METHODSFrom June 2008 to February 2009 full-thickness of meniscal defects were created in the anterior corner of goats, which with no blood supply, in a diameter of 2 mm. Then bone marrow stem cells (BMSCs) was mixed with injectable calcium alginate gel to fill the defects. Other groups include the calcium alginate gel and empty group were served as control groups. At different time points, the animals were sacrificed and macroscopy, microscopy determination, electroscopy and MRI detection were performed to assess the outcomes of repairing.

RESULTSThe meniscal defects had been filled thoroughly in 16 weeks after operation with white, tough and elastic repair tissue similar to normal meniscal fibrocartilage in the tissue engineering groups. The repair tissue was mainly fibrochondrocytes in line with the calcium alginate fiber. Thick matrix secreted by the cells crammed the space between fibers. The view under electroscopy demonstrated that the microstructure of the repair tissue was normal and cells were in a fibrocartilage phenotype.

CONCLUSIONThe full-thickness meniscal defects in regions without blood supply can be reconstructed effectively with injectable tissue engineering.

Alginates ; Animals ; Bone Marrow Cells ; Cells, Cultured ; Disease Models, Animal ; Gels ; Glucuronic Acid ; Goats ; Hexuronic Acids ; Injections ; Male ; Stem Cells ; Tibial Meniscus Injuries ; Tissue Engineering ; methods ; Tissue Scaffolds

BACKGROUNDSpinal hyperbaric ropivacaine may produce more predictable and reliable anesthesia than plain ropivacaine for cesarean section. The dose-response relation for spinal hyperbaric ropivacaine is undetermined. This double-blind, randomized, dose-response study determined the ED50 (50% effective dose) and ED95 (95% effective dose) of spinal hyperbaric ropivacaine for cesarean section anesthesia.

METHODSSixty parturients undergoing elective cesarean section delivery with use of combined spinal-epidural anesthesia were enrolled in this study. An epidural catheter was placed at the L1 approximately L2 vertebral interspace, then lumbar puncture was performed at the L3 approximately L4 vertebral interspace, and parturients were randomized to receive spinal hyperbaric ropivacaine in doses of 10.5 mg, 12 mg, 13.5 mg, or 15 mg in equal volumes of 3 ml. Sensory levels (pinprick) were assessed every 2.5 min until a T7 level was achieved and motor changes were assessed by modified Bromage Score. A dose was considered effective if an upper sensory level to pin prick of T7 or above was achieved and no intraoperative epidural supplement was required. ED50 and ED95 were determined with use of a logistic regression model.

RESULTSED50 (95% confidence interval) of spinal hyperbaric ropivacaine was determined to be 10.37 (5.23 approximately 11.59) mg and ED95 (95% confidence interval) to be 15.39 (13.81approximately 23.59) mg. The maximum sensory block levels and the duration of motor block and the rate of hypotension, but not onset of anesthesia, were significantly related to the ropivacaine dose.

CONCLUSIONThe ED50 and ED95 of spinal hyperbaric ropivacaine for cesarean delivery under the conditions of this study were 10.37 mg and 15.39 mg, respectively. Ropivacaine is suitable for spinal anesthesia in cesarean delivery.

Adult ; Amides ; pharmacology ; Anesthesia, Obstetrical ; Anesthesia, Spinal ; Anesthetics, Local ; pharmacology ; Cesarean Section ; Dose-Response Relationship, Drug ; Double-Blind Method ; Female ; Humans ; Logistic Models ; Pregnancy

OBJECTIVETo investigate the transfection efficiency and the optimal conditions of delivering latent membrane protein-1 (LMP-1) gene to dendritic cells (DCs) by ultrasound exposure combined with contrast agent.

METHODSHuman DCs were cultured in vivo and transfected with the recombinant plasmid pEGFP-C3-LMP1 under varying conditions including ultrasound intensities, exposure time and microbubble contrast agent concentration. The transfection efficiency was assessed by fluorescent microscopy and flow cytometry, and the cell viability by trypan blue exclusion test.

RESULTSAn exposure time of 60 s at MI 1.0 with a microbubble contrast agent concentration of 20% resulted in the optimal effect of delivering the recombinant plasmid pEGFP-C3-LMP1 into the DCs, with a transfection efficiency of (14.37∓2.12)%. Over 90% of the transfected cells were viable after the transfection.

CONCLUSIONMicrobubble contrast agent combined with ultrasound exposure can enhance the delivery of recombinant plasmid pEGFP-C3-LMP1 into the DCs.

Adaptor Proteins, Signal Transducing ; genetics ; Cells, Cultured ; Contrast Media ; administration & dosage ; pharmacology ; Cytoskeletal Proteins ; genetics ; Dendritic Cells ; drug effects ; metabolism ; Humans ; LIM Domain Proteins ; genetics ; Microbubbles ; Plasmids ; Transfection ; Ultrasonics

OBJECTIVETo introduce the biplanar opening high tibial osteotomy with rigid fixation for adult varus knee.

METHODSTwelve patients with varus knee and degeneration of medial compartment received the biplanar opening high tibial osteotomy between June 2001 and July 2008. The pre-operative deformity was about 11.5 degrees without osteoarthritis changes in other compartments. The average range of motion was more than 90 degrees . One of the patients had ruptures of LCL and ACL, who received osteotomy after reconstruction of the ligaments. The main symptom before the operation was pain in medial compartment. The range of motion, Lysholm score and subjective satisfactory examinations were assessed before and after the osteotomy.

RESULTSAll of the osteotomy sites were healed at twelve to sixteen weeks after operation. No complications such as plate broken or injury of nerve or blood vessel had occurred. The mean correct angle was 9.5 degrees . No degenerative changes had developed in other compartments of the knee. The mechanical axis of the lower extremities was maintained during the follow-up. The overall satisfactory rate was 83.3%. Statistically significant changes exist in the Lysholm score and varus degree.

CONCLUSIONThe open-wedge high tibial osteotomy is suitable for the symptomatic genu varum in younger patients with good short-term and mid-term results.

Adult ; Female ; Humans ; Joint Deformities, Acquired ; surgery ; Knee Joint ; Male ; Middle Aged ; Osteotomy ; methods ; Retrospective Studies ; Tibia ; surgery ; Treatment Outcome

BACKGROUNDIn patients with chronic total occlusion (CTO) and multivessel coronary artery disease, the comparison of surgical and the percutaneous revascularization strategies has rarely been conducted. The aim of this study was to compare long term clinical outcomes of drug eluting stent (DES) implantation with coronary artery bypass surgery (CABG) in the patients with CTO and multivessel disease.

METHODSFrom a prospective registry of 6000 patients in our institution, we included patients with CTO and multivessel coronary artery disease who underwent either CABG (n = 679) or DES (n = 267) treatment. Their propensity risk score was used for adjusting baseline differences.

RESULTSAt a median follow-up of three years, propensity score adjusted Cox regression analysis showed that the rate of major adverse cardiac cerebrovascular events (MACCE) was lower in CABG group (12.7% vs. 24.3%, hazard ratio (HR) 1.969, 95%CI 1.219 - 3.179, P = 0.006) mainly due to lower rate of target vessel revascularization in CABG group than in DES group (3.1% vs. 17.2%, HR 16.14, 95%CI 5.739 - 45.391, P < 0.001). The incidence of cardiac death or myocardial infarction (composite end point) was not significantly different between these two groups. On multivariate analysis, the significant predictors of MACCE were only the type of revascularization. Age, left ventricular ejection fraction (LVEF), and complete revascularization were identified as significant predictors of composite end points.

CONCLUSIONSOur study shows that in patients with CTO and multivessel coronary disease, DES can offer comparable long term outcomes in cardiac death and myocardial infraction free survival in comparison with CABG. However, there is an increased rate of MACCE which results from more repeat revascularizations. Obtaining a complete revascularization is crucial for decreasing adverse cardiac events.

Angioplasty, Balloon, Coronary ; methods ; Chronic Disease ; Coronary Angiography ; Coronary Artery Bypass ; methods ; Coronary Artery Disease ; surgery ; therapy ; Coronary Occlusion ; surgery ; therapy ; Drug-Eluting Stents ; Humans ; Prospective Studies

OBJECTIVETo assess the acceptability and influence factors of early antiretroviral therapy (ART) among HIV-positive men who have sex with men (MSM) .

METHODSFrom June to August 2012, through convenience sampling, HIV-positive MSM who were willing to cooperate with the survey were selected from the Hangzhou and Ningbo AIDS prevention and control database. A total of 280 HIV-positive MSM who did not receive ART participated in the study.Using self-designed questionnaire, general demographic information, awareness of AIDS knowledge, sexual behavior, use of condom, current physical condition, awareness and attitude towards early ART were investigated.Excluding 60 HIV-infected MSM whose CD4(+)T count didn't meet the inclusion criteria, a total of 220 subjects were included in the analysis. Chi-square was used to compare the difference of early ART acceptance among subjects with different characteristics.Non-conditional logistic regression was used to analyze the influence factors of the acceptability of early ART.

RESULTSThe acceptance rate of early ART among HIV-infected MSM was 62.7% (138/220). Delaying the disease development, preventing partners from infection, not worrying others to suspect them of having HIV, and partners unknowing the HIV-infected status were the factors which had a relatively higher acceptance rate of early ART. Correspondingly, the acceptance rate was 68.8% (130/189), 68.7% (103/150), 78.4% (69/88) and 72.5% (74/102) respectively and the acceptance rate among subjects with opposite opinions or characteristics was 24.1% (7/29) , 50.0% (30/60), 52.7% (68/129) and 45.8% (58/107) respectively (chi-square values were 21.46, 6.43, 14.84 7.55, all P values <0.05).Logistic regression analysis showed that delaying the disease development (OR = 11.50, 95%CI:3.29-40.22) and preventing partners from infection (OR = 3.72, 95%CI:1.53-9.03) were inclined to the acceptance of early ATR.While concerning others' suspection of them having HIV (OR = 0.19, 95%CI:0.08-0.48) and partners knowing the HIV-infected status were inclined to unacceptance of ART(OR = 0.31, 95%CI:0.13-0.70).

CONCLUSIONThe acceptability of early ART among HIV-positive MSM is high. The recognition of early ART and concern of privacy leak are the major influence factors which can stimulate the acceptance of early ART.

Adolescent ; Adult ; Antiretroviral Therapy, Highly Active ; HIV Infections ; drug therapy ; prevention & control ; psychology ; Homosexuality, Male ; psychology ; Humans ; Logistic Models ; Male ; Middle Aged ; Patient Acceptance of Health Care ; Young Adult

BACKGROUNDThe optimal revascularization strategy in patients with heart failure with preserved ejection fraction (HFPEF) remains unclear. The aim of the present study was to compare the effects of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in patients with HFPEF.

METHODSFrom July 2003 through September 2005, a total of 920 patients with coronary artery disease (CAD) and HFPEF (ejection fraction ≥ 50%) underwent PCI (n = 350) or CABG (n = 570). We compared the groups with respect to the primary outcome of mortality, and the secondary outcomes of main adverse cardiac and cerebral vascular events (MACCE), including death, myocardial infarction, stroke and repeat revascularization, at a median follow-up of 543 days.

RESULTSIn-hospital mortality was significantly lower in the PCI group than in the CABG group (0.3% vs. 2.5%, adjusted P = 0.016). During follow-up, there was no significant difference in the two groups with regard to mortality rates (2.3% vs. 3.5%, adjusted P = 0.423). Patients receiving PCI had higher MACCE rates as compared with patients receiving CABG (13.4% vs. 4.0%, adjusted P < 0.001), mainly due to higher rate of repeat revascularization (adjusted P < 0.001). Independent predictors of mortality were age, New York Heart Association (NYHA) class and chronic total occlusion.

CONCLUSIONAmong patients with CAD and HFPEF, PCI was shown to be as good as CABG with respect to the mortality rate, although there was a higher rate of repeat revascularization in patients undergoing PCI.

Aged ; Angioplasty, Balloon, Coronary ; mortality ; Coronary Artery Bypass ; mortality ; Female ; Heart Failure ; physiopathology ; therapy ; Hospital Mortality ; Humans ; Male ; Middle Aged ; Stents

BACKGROUNDC-reactive protein (CRP) is a lowly expressed marker for inflammatory response. This study aimed to evaluate the prognostic value of baseline CRP levels in patients undergoing coronary revascularization in the context of modern medical treatment.

METHODSThis was a retrospective study in a single center. Four hundred and fourteen patients were enrolled, who underwent coronary revascularization and received adequate medication for secondary prevention of coronary heart disease. The study compared the follow-up clinical outcomes between high level CRP group (CRP > 5 mg/L) and low level one. The median follow-up time was 551 days.

RESULTSCompared with low CRP group, the relative risk (RR) of the major adverse cardiovascular and cerebral events (MACCE) in high CRP group was 5.131 (95%CI: 1.864-14.123, P = 0.002). There were no significant differences in death, myocardial infarction and stroke during the follow-up between two groups, but a higher risk of re-revascularization was found in high CRP group (RR 6.008, 95%CI: 1.667-21.665, P = 0.006). Cox regression analysis showed that only CRP level could contribute to MACCE during the follow-up. MACCE-free rate was much lower in high CRP group (Kaplan-Meier log-rank P < 0.001).

CONCLUSIONIn the context of modern medical treatment, the baseline level of CRP is an independent predictor for long-term prognosis in patients with coronary revascularization.

Aged ; C-Reactive Protein ; metabolism ; Coronary Disease ; metabolism ; surgery ; Female ; Humans ; Male ; Middle Aged ; Myocardial Revascularization ; methods ; Retrospective Studies

BACKGROUNDIt has been proven that ultrasonic destruction of microbubbles can enhance gene transfection efficiency into the noncardiac cells, but there are few reports about cardiac myocytes. Moreover, the exact mechanisms are not yet clear; whether the characteristic of microbubbles can affect the gene transfection efficiency or not is still controversial. This study was designed to investigate whether the ultrasound destruction of gene-loaded microbubbles could enhance the plasmids carried reporter gene transfection in primary cultured myocardial cell, and evaluate the effects of microbubbles characteristics on the transgene expression in cardiac myocytes.

METHODSThe β-galactosidase plasmids attached to the two types of microbubbles, air-contained sonicated dextrose albumin (ASDA) and perfluoropropane-exposed sonicated dextrose albumin (PESDA) were prepared. The gene transfection into cardiac myocytes was performed in vitro by naked plasmids, ultrasound exposure, ultrasonic destruction of gene-loaded microbubbles and calcium phosphate precipitation, and then the gene expression and cell viability were analyzed.

RESULTSThe ultrasonic destruction of gene-loaded microbubbles enhanced gene expression in cardiac myocytes compared with naked plasmid transfection ((51.95 ± 2.41) U/g or (29.28 ± 3.65) U/g vs. (0.84 ± 0.21) U/g, P < 0.01), and ultrasonic destruction PESDA resulted in more significant gene expression than ASDA ((51.95 ± 2.41) U/g vs. (29.28 ± 3.65) U/g, P < 0.05). Ultrasonic destruction of microbubbles during calcium phosphate precipitation gene transfection enhanced β-galactosidase activity nearly 8-fold compared with calcium phosphate precipitation gene transfection alone ((111.35 ± 11.21) U/g protein vs. (14.13 ± 2.58) U/g protein, P < 0.01). Even 6 hours after calcium phosphate precipitation gene transfection, ultrasound-mediated microbubbles destruction resulted in more intense gene expression ((35.63 ± 7.65) U/g vs. (14.13 ± 2.58) U/g, P < 0.05).

CONCLUSIONSUltrasonic destruction of microbubbles might be a promising method for the delivery of non-viral DNA into cardiac myocytes, and the gene tranfection is related to the characteristics of microbubbles.

Albumins ; Animals ; Cell Survival ; genetics ; physiology ; Cells, Cultured ; Microbubbles ; Myocytes, Cardiac ; cytology ; metabolism ; Rats ; Rats, Wistar ; Transfection ; methods ; Ultrasonics ; methods ; beta-Galactosidase ; genetics ; metabolism

OBJECTIVETo evaluate the risk factors related to mortality in old patients with coronary heart disease after revascularization.

METHODSA total of 675 patients (498 males) with age >or= 70 years old who received revascularization during July 2003 to June 2004 and followed up > 30 days after discharge were included in this study. Clinical characteristics, death and major adverse cardiac and cerebral events (MACCE) during follow up were recorded.

RESULTSThe patients were followed up for a mean period of (754 +/- 355) days. 27 patients (4.0%) died and MACCE developed in 50 patients (7.4%) during follow up. Female and patients with anemia took a significantly higher risk of mortality (RR = 2.750, 95% CI 1.116 - 6.779, P = 0.028, RR = 0.385 95% CI 0.164 - 0.904, P = 0.028, respectively); Creatinine level is positively related to mortality rate. When comparing patients with Cr > 115 micromol/L and Cr > 177 micromol/L with patients with Cr < 115 micromol/L, the hazard rate was 2.963 and 10.785, respectively (95% CI 1.114 - 9.952, P = 0.035 and 95% CI 2.659 - 78.097, P = 0.000) after adjustment for other risk factors.

CONCLUSIONPreexisting anaemia (male Hb < 120 g/L, female Hb < 110 g/L), renal insufficiency (Cr > 115 micromol/L) and female gender were found to be independent risk factors for mortality in old patients with coronary heart disease post revascularization.

Aged ; Aged, 80 and over ; Coronary Disease ; mortality ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Myocardial Revascularization ; Postoperative Period ; Prognosis ; Regression Analysis ; Risk Factors ; Sex Factors ; Survival Analysis