BACKGROUND:The traditional treatment methods for osteoporosis accompanied by bone defects, such as autogenous bone graft, al ograft, biomaterial implants, have significant limitations. The regenerative medicine approach using adipose-derived stem cells as seed cells offers a new way for the repair of bone defects fol owing osteoporosis. OBJECTIVE:To review the pathogenesis of osteoporosis and its impacts on the repair of bone defects, the signal pathway regulation of osteogenic differentiation of adipose-derived stem cells, and the feasibility of adipose-derived stem cells for repairing osteoporotic bone defects. METHODS:A computer-based online search of CNKI database and PubMed database was performed to retrieve the relevant articles published from January 1998 to September 2014 with the key words of“adipose-derived stem cells, osteoporosis, bone defect, osteogenic differentiation, bone regeneration”in Chinese and English, respectively. Final y 77 articles were included for review after deleting unrelated and repetitive ones. RESULTS AND CONCLUSION:In recent years, adipose-derived stem cells have been widely used in regenerative medicine research. With the development of relevant disciplines such as regenerative medicine, tissue engineering, molecular biology, and material science, in-depth studies on regulatory mechanisms of osteogenic differentiation of adipose-derived stem cells have been developed. Adipose-derived stem cells combined with biological scaffolds for construction of tissue-engineered bones provides a new way to repair osteoporotic bone defects.

One hundred and twenty patients with senile primary osteoporosis were enrolled in the study from January 2012 to April 2013,including 41 males and 79 females.Patients were randomly assigned to two groups:60 patients in study group were treated with salmon calcitonin combined with zoledronic acid (salmon calcitonin 50 IU i.m,q.d for 7 d,then 100 IU q.i.d for 7 d,followed by zoledronic acid 5 mg i.v gtt/y);60 cases in control group were treated with alendronate (70 mg p.o/wk).Both groups received the same doses of calcium.Visual analogue scale (VAS) scores were assessed before,and 1,6 and 12 months after treatment,12-Item Short-Form Health Survey (SF-12) and bone mineral density (BMD) were assessed before and 12 months after treatment.There were no significant differences in all baseline parameters between two groups (P ＞ 0.05).After 1 month of treatment,the VAS scores of study group was lower than that of the control group (2.1 ± 3.0 vs.4.2 ± 3.1,P ＜ 0.05),however,both groups had similar improvements in VAS scores in 6 and 12 months after the treatment (P ＞0.05).Compared to those before treatment,physical component summary and mental component summary of SF-12 scores after 1 year of treatment were improved significantly in both groups (P ＜ 0.05).Also,BMD was significantly improved after 1 year of treatment in both groups (P ＜ 0.05).The incidence of side effect in study group was lower than that in control group (16％ vs.20％,P ＜0.05).The results indicate that salmon calcitonin combined with zoledronic acid is an effective,safe,reliable and well tolerated therapy for senile primary osteoporosis.The long-term outcomes remain to be determined.

Objective To compare the clinical outcomes between proximal femoral nail antirotation (PFNA) combined with salmon calcitonin and PFNA only for the treatment of unstable intertrochanteric fractures in elderly patients.Methods From January 2009 to December 2011,120 elderly patients with intertrochanteric fracture were randomly divided into two groups:calcitonin group and control group.Patients in calcitonin group were treated with PFNA combined with salmon calcitonin,while patients in control group were treated with PFNA only.According to Evans-Jensen classification,60 patients in calcitonin group (28 males and 32 females,with an average age of 75.1 years) were divided into 20 cases of type Ⅱ A,32 cases of type Ⅱ B and 8 type Ⅲ.Sixty patients in control group (27 males and 33 females,with an average age of 74.9 years) were divided into 22 cases of type Ⅱ A,32 cases of type Ⅱ B and 6 type Ⅲ.Bone healing was assessed with X-ray and bone mineral density (BMD) was measured by dual energy X-ray absorptiometry.Harris hip and SF-12 score,complications,adverse effect of salmon calcitonin and subsequent fragility fractures were evaluated postoperatively.Results One-hundred and thirteen patients were followed up for at least 2 years.In 6 months after surgery,there were 4 cases of delayed healing in control group.However,all fractures were healed in 12 months after surgery.No significant difference was found between the two groups in BMD preoperatively.The changes in BMD were significantly different between the two groups in 6 months,1 year and 2 years after surgery.No significant difference was found between the two groups in Harris hip and 1-year SF-12 score while the 2-year SF-12 score was significantly different between the two groups.There was 1 patient in calcitonin group who suffered from subsequent fragility fracture in 3 months after surgery,while there was 6 patients in control group during 13 to 23 months postoperatively.Conclusion PFNA combined with salmon calcitonin achieves good effect for the treatment of unstable intertrochanteric fractures in elderly patients.

Objective To compare the clinical results of arthroscopic rotator cuff repair using a suture bridge technique and conservative therapy as treatment of traumatic shoulder dislocation combined with rotator cuff injury in older patients. Methods From August 2010 to August 2013 a total of 63 patients were prospectively enrolled. In the case of documented tears of the rotator cuff in combination with symptoms persisting after conservative therapy, patients were free to decide between arthroscopic rotator cuff repair using a suture bridge technique and conservative treatment. Patients were monitored for changes in visual analogue scale (VAS) scores, range of motion, the Simple Shoulder Test (SST), the Constant score and recurrences over a minimum follow-up period of 1 year. Results 60 pa-tients (30 in surgical group and 30 in conservative treatment group) were follow-up for at least 1 year. There was no significant difference between the two groups at baseline. The surgical group resulted in better improvements in pre-operative to postoperative VAS scores, range of motion, SST scores and the Constant score. There were five recur-rences in the conservative treatment group, while no recurrences were documented in surgical group. Conclusion In this selected patient group, we believe arthroscopic repair using a suture bridge technique for the treatment of symp-tomatic rotator cuff tear can improve shoulder function and decrease recurrences in older patients suffered from trau-matic shoulder dislocation combined with rotator cuff injury. The long-term outcomes remain to be determined.

Objective To study the treatment effect of synovectomy under arthroscope on elbow rheumatoid arthritis.Methods 38 patients with elbow rheumatoid arthritis were selected as the research subjects,received arthroscopic synovial treatment,surgical procedures require more than one direction into the intra -articular,cleaning elbow joint synovial,complete removal of the foreign body cavity.Postoperative follow -up for 30 months,and com-pared the patients'Mayo elbow performance score and joint activity situation before and after surgery.Results After surgery,Elbow pain score[(30.12 ±8.11)points],activity level[(17.01 ±2.88)points],joint function[(20.67 ± 5.01)points]and total score[(73.04 ±12.01)points]were significantly higher than the pre -operative[(3.98 ± 3.89)points,(9.78 ±5.02)points,(13.77 ±3.69)points,(33.04 ±10.01)points](t =18.38,P <0.05;t =7.90, P <0.05;t =7.01,P <0.05;t =16.18,P <0.05 ).After surgery,elbow flexion activity score [(113.12 ± 15.11)points]was significantly higher than the preoperative flexion elbow activity score[(93.03 ±19.89)points] (t =5.09,P <0.05 ).Conclusion Treated elbow rheumatoid arthritis by synovectomy under arthroscope could effectively improve the disease status of patients,relieve pain,enhance mobility,allowing patients to gradually return to normal life,and it can be widely used in clinical practice.

Objective To investigate the clinical results of arthroscopic FaxT -Fix technology vertical mat-tress suture for patients with meniscal tear Ⅲ level.Methods 50 cases with the level of meniscal Ⅲ orthopedic treatment of torn were divided into two groups using random number table,25 cases in each group.The control group received a simple meniscectomy,the observation group was given arthroscopic FaxT -Fix technology vertical mattress suture.Surgery and prognosis function were observed and compared in the two groups during recovery.Results The operation time (26.53 ±7.34)min,postoperative functional activity recovery time (25.01 ±9.55)d and hospital stay (5.68 ±2.01)d of the observation group were significantly shorter than the control group[(46.66 ±12.28)min, (39.53 ±11.28)d,(9.98 ±3.34)d],the differences were statistically significant (t =7.04,4.91,5.52,all P <0.05).3,6,12,18 months after operation,the improvements of Lysholm and IKDC scores of the observation group were significantly better than the control group (t =3.60,2.64,2.81,3.03,4.94,2.12,2.28,2.32,all P <0.05). During the postoperative follow -up period,the incidence rate of complications of the observation group (4.00%) was significantly lower than the control group (24.00%)(χ2 =4.15,P <0.05).Conclusion For patients with level of Ⅲ meniscus tear,arthroscopic FaxT -Fix technology vertical mattress suture can effectively reduce the surgery and hospitalization time,promote functional recovery of the patients 'knee,significantly improve the postoperative Lysholm knee score and IKDC,but also significantly reduce postoperative wound infection,hematoma,nerve damage vascular complication rate.

Objective To make a clinical summary of the variation of cystic duct so as to collect 20 years of operative experience and to provide evidence for preventing injury of bile duct in laparoscopic cholecystectomy. Methods A retrospective analysis were made for 20 000 patients experienced laparoscopic cholecystectomy in the second affiliated hospital of Chongqing medical university and Chonggang General Hospital from April,1993 to December,2011. Results There were 3 265 cases of cystic duct variation which occupied 16. 33% of the 20 000 patients. And there were 3 200 cases of variation in the junction of cystic duct, 51 cases of short cystic duct;and 14 cases of gall-bladder surrounded by the liver. Most of the variation were found in the junction of cystic duct, including 371 cases (11. 36%) of cystic duct accompanied the common hepatic duct and then made a lower confluence;995 cases (30. 47%) of cystic duct traversed above the com-mon hepatic duct and then made a confluence, 643 cases (19. 69%) of cystic duct traversed below the common hepatic duct and then made a confluence;963 cases (29. 49%) of gallbladder neck attached to the common bile duct;and 228 cases (6. 98%) of higher confluence of cystic duct and common bile duct. Conclusion The rate of cystic duct variation accounted for a high rate, and most of the patients were found with a variation in the junction of cystic duct. Being familiar with the categories of cystic duct, discriminating the anatomic structure carefully, using choledochoscopic examination when necessary, and masterting reasonable time to make a transfer to laparocholecystotomy were reliable methods for coping with the injury of bile duct caused by variation of cystic duct.

Objective To investigate the clinical outcomes of arthroscopic rotator cuff repair using improved-press-ift double-row technique for patients of large rotator cuff tear.Methods From December 2013 to November 2014, 52 patients (20 males, 32 females) with a full-thickness large rotator cuff tear underwent arthroscopic improved-press-ift double-row repair were retrospectively analyzed. The mean age of the patients was 65.6 years (range 51 to 76 years). The visual analog pain scale scores (VAS), the range of motion (ROM), University of California at Los Angeles (UCLA), and American Shoulder and Elbow Surgeons (ASES) were used for clinical and functional evaluations before surgery and at the time of 6 months after arthroscopy.Results The mean duration of follow-up was 10.9 months (range 6 to 17 months). At the time of 6 months after arthroscopy, the mean subjective pain score (VAS) was (1.6 ± 0.9), the mean active forward flexion was (145.6 ± 10.7)°, whereas the mean external rotation at the side was (30.8 ± 8.5)°. The mean UCLA score improved to (32.3 ± 3.5), the mean ASES score improved to (81.8 ± 8.7). There was significant difference postoperatively (P < 0.05). No re-tear occurred.Conclusion The improved-press-ift DR technique is effective in arthroscopic large rotator cuff repairing. Compared with suture-bridge technique, this technique can decrease operation time, costs, and is much easier to process.

Bipolar Disorder ; blood ; immunology ; metabolism ; Depressive Disorder ; blood ; immunology ; metabolism ; Humans ; Proteomics

Objective To investigate the possible association of IRAK4 polymorphisms with susceptibility to and prognosis of severe sepsis.Methods A total of 192 patients hospitalized in emergency department of Zhongshan Hospital from February 2006 to December 2009,and another 192 healthy volunteers were enrolled in this case-control study.Patients were excluded if they had metastatic tumors,autoimmune diseases,AIDS or received immunosuppressive drugs.This study was approved by the ethical committee of Zhongshan Hospital,Fudan University.Sepsis patients were divided into survival group(n =124)and non-survival group(n =68)according to the 30-day mortality.Primer 3 software was used to design the PCR and sequencing primers.Genomic DNA was extracted from peripheral blood mononuclear cells.Seven tagSNPs were selected based on the data of Chinese Han in Beijing from the Hapmap projectand genotyped by direct sequencing.We used x2 analysis to evaluate the significance of differences in genotype and allele frequencies between different groups.Results The distributions of all tagSNPs were consistent with Hardy-Weinberg equilibrium.The allele and genotype frequencies of rs4251545(G/A)were significantly different between severe sepsis and healthy control groups(P =0.015,P =0.035,respectively).Carriers of the rs4251545A had a higher risk for severe sepsis compared with carriers of the rs4251545G(OR =1.69,95％ CI:1.10-2.58).The allele and genotype frequencies of all SNPs were not significantly different between survivor group and non-survivor group.Conclusions These findings indicated that the variants in IRAK4 are significantly associated with severe sepsis susceptibility in the Chinese Han population.