OBJECTIVETo study the expression of lipoprotein related genes in subchondral bone of early experimental os-teoarthritis, which may play an important role in the pathogenesis of osteoarthritis.

METHODSAnimals are equally divided into two groups: experimental group and control group, both of which contain fifteen rats of similar weight. The right knee joints of experimental group underwent surgery,which involved in both medial collateral ligament(MCL) transaction and medial meniscectomy, while the control group was only carried out with a sham operation. Rats were killed at 1, 2 and 4 weeks postsurgery to obtain the right knee joints. Total RNA of the subchondral bone was extracted,and then hybridized to Agilent Whole Rat Genome Microarray. Differentially expressed genes analysis was used to study the chemokine signaling pathway.

RESULTSApoa5 expression was down-regulated at 1, 2 weeks post-surgery, Apoc2 expression was up-regulated at 1 week after surgery, Apol3 expression was up-regulated at 1 and down-regulated at 4 weeks post-surgery, Lrp1 expression was down-regulated at 1, 2 weeks after surgery. Lrp5 was down-regulated at 2 weeks after surgery. Gpihbp1, Lpl, Tfpi and Vldlr were up-regulated at 1 weeks after surgery. Lrpap1 and RGD1309808 were down-regulated at 4 weeks after surgery.

CONCLUSIONDysregulation of lipoprotein related genes plays an important role in pathogenesis of early experimental osteoarthritis.

Animals ; Disease Models, Animal ; Knee Joint ; metabolism ; Lipoproteins ; genetics ; Male ; Oligonucleotide Array Sequence Analysis ; Osteoarthritis ; genetics ; Rats ; Rats, Sprague-Dawley ; Transcriptome

OBJECTIVETo evaluate the arthroscopic diagnosis and treatment of the chronic ankle pain after injury.

METHODSFrom April 1999 to June 2008, 39 patients with posttraumatic chronic ankle pain were treated. The mean duration between the initial injury and treatment was 18 months (2 months to 11 years). There were 15 males and 24 females with a mean age of 32 years (15 to 58 years). All the patients were treated with arthroscopic debridement. The preoperative and postoperative ankle functions were evaluated by the AOFAS (the American Orthopaedic Foot and Ankle Society) Clinical Rating System for the ankle-hindfoot.

RESULTSTwenty-six patients had osteochondral lesions. Impingement syndrome in ankle was observed in 21 patients. The impingement tissue included synovial hypertrophy in 3 patients, ligament injury in 10 patients (7 patients had anterior talofibular ligament injury and 3 patients had anteroinferior tibiofibular ligament injury), meniscoid tissue in 6 patients, pathological labrum in 3 patients. All the patients were followed up with an average of (14.2+/-8.4) months (ranged from 5 to 36 months). The AOFAS scores increased significantly from pre-operative (59.7+/-16.9) to post-operative (68.8+/-21.2), and it was obvious in relieving pain, which was pre-operative (22.8+/-10.0) and post-operative (29.5+/-12.1).

CONCLUSIONArthroscopy can be used to diagnose the cause of chronic ankle pain after injury. Furthermore, arthroscopic debridement was useful to relieve the pain and improve the joint function, and it is appropriate for patients who had no fractures and dislocations.

Adolescent ; Adult ; Ankle Injuries ; complications ; surgery ; Ankle Joint ; pathology ; surgery ; Arthroscopy ; methods ; Debridement ; methods ; Female ; Humans ; Male ; Middle Aged ; Treatment Outcome ; Young Adult

OBJECTIVETo evaluate the clinical outcome of arthroscopically assisted combined anterior and posterior cruciate ligament (ACL/PCL) reconstructions using Achilles tendon-bone allografts.

METHODSAssociated meniscus injuries were treated according to established methods prior to ligament reconstructions during arthroscopic surgery. Thirty Achilles tendon-bone allografts were used to reconstruct torn ACL and PCL in 15 knees. At postoperative follow-up, all knees were graded using the modified IKDC and the Lysholm scoring systems just as done preoperatively.

RESULTSwere analyzed compared with the contralateral healthy knees. Results: Eleven men and 4 women with a minimum of 3-year follow-up (mean 38 months) were included in the study. Preoperatively, the group ratings by the modified IKDC standards were all severely abnormal. Twelve bicruciate reconstructions were performed in subacute or chronic stage (larger than 3-8 weeks), 3 for acute ligamentous deficiencies (less than or equal to 3 weeks). The noticeable early complication was transitory local fever combined with joint effusion in one case. At postoperative follow-up, 9 knees were normal, 5 nearly normal and 1 abnormal. On Lysholm score the difference was statistically significant (t- test, P less than 0.001) before and after operation.

CONCLUSIONSAchilles tendon-bone allograft offers an alternative for simultaneous arthroscopic ACL/PCL reconstructions. However, further investigation is needed to eradicate its potential immunogenicity for better use.

Achilles Tendon ; transplantation ; Anterior Cruciate Ligament ; surgery ; Arthroscopy ; methods ; Bone Transplantation ; methods ; Female ; Humans ; Knee Injuries ; surgery ; Male ; Posterior Cruciate Ligament ; surgery ; Range of Motion, Articular ; Reconstructive Surgical Procedures ; methods ; Transplantation, Homologous

There is a dearth of case reports describing simultaneous bilateral patellar tendon ruptures in the medical literature. These ruptures are often associated with systemic disorders such as lupus erythematosus or chronic steroid use. The author describes a case of a 24-year-old man who sustained traumatic bilateral patellar tendon ruptures without any history of systemic disease or steroidal medication. We repaired and reattached the ruptured tendons to the patella and augmented our procedure with allogeneic tendon followed by wire loop reinforcement. One year after operation, the patient regained a satisfactory range of motion of both knees with good quadriceps strength and no extensor lag. The recurrent microtrauma from a history of intense sports activity and a high body mass index may have played an important role in this trauma event.
Humans ; Knee Injuries ; Patella ; injuries ; Patellar Ligament ; Rupture ; Tendon Injuries ; surgery

OBJECTIVETo study the feasibility of regenerating a whole menisci using poly-(3-hydroxybutyrate-co-3-hydroxyvalerate) (PHBV) scaffolds loaded with meniscal cells in rabbits undergoing total meniscectomy, and to explore its protective effect on cartilage degeneration.

METHODSA solvent casting and particulate leaching technique was employed to fabricate biodegradable PHBV scaffolds into a meniscal shape. The proliferated meniscal cells were seeded onto the polymer scaffolds, transplanted into rabbit knee joints whose lateral menisci had been removed. Eight to 18 weeks after transplantation, the rege- nerated neomenisci were evaluated by gross and histological observations. Cartilage degeneration was assessed by Mankin score.

RESULTSEighteen weeks after transplantation, the implants formed neomenisci. Hematoxylin and eosin (HE) staining of the neomenisci sections revealed regeneration of fibrocartilage. Type I collagen in the neomenisci was also proved similar to normal meniscal tissue by immunohistochemical analysis and Sirius scarlet trinitrophenol staining. Articular cartilage degeneration was observed 8 weeks after implantation. It was less severe as compared with that in total meniscectomy controls and no further degeneration was observed at 18 weeks. At that time, the regenerated neomenisci strongly resembled normal meniscal fibrocartilage in gross and histological appearance, and its mechanical property was also close to that of normal meniscus.

CONCLUSIONSThe present study demonstrates the feasibility of tissue-engineering a whole meniscal structure in total meniscectomy rabbit models using biodegradable PHBV scaffolds together with cultured allogeneic meniscal cells. Cartilage degeneration is decreased. But long-term in vivo investigations on the histological structure and cartilage degeneration of the neomenisci regenerated by this method are still necessary to determine the clinical potential of this tissue engineering avenue.

Animals ; Cartilage, Articular ; Cells, Cultured ; Knee Joint ; Menisci, Tibial ; Polymers ; Regeneration ; Tissue Engineering

OBJECTIVETo study the characteristics of inheritance and epidemiology of gallstone disease in one pedigree.

METHODSA gallbladder disease-specific questionnaire was administered to all family members to ascertain histories of cholecystectomy and other medical conditions as well as anthropometrical data. Laboratory examination and ultrasonography were performed to determine the existence of gallstone.

RESULTSOne hundred and thirteen members of four generations in the index family were enrolled in the study. The prevalence of gallstone in females (34.48%) was higher than in males (23.64%) but with no significant difference. The prevalence in the second and third generations (52%) was higher than in others (20%) (P < 0.05). The heritability and standard error showed as 86.38% +/- 46.46% in I generations. Body mass index, histories of hypertension, hyperlipidemia and blood glucose were positively related to gallstone disease (P = 0.012, < 0.01, 0.017, 0.043, respectively) in this family. Gallstone disease was not significantly related to history of diabetes, daily alcohol or diet habit. Plasma cholesterol and triglyceride levels were not correlated with gallstone disease.

CONCLUSIONGallstone disease presented aggregation in the family and was in accordance with the characteristics of autosomal dominant inheritance. Being female, obesity, hypertension and history of hyperlipidemia might serve as risk factors to this family.

Adolescent ; Adult ; China ; epidemiology ; Family Health ; Female ; Gallstones ; epidemiology ; genetics ; Genetic Predisposition to Disease ; genetics ; Humans ; Hyperlipidemias ; complications ; Hypertension ; complications ; Male ; Middle Aged ; Obesity ; complications ; Pedigree ; Prevalence ; Risk Factors ; Sex Factors ; Surveys and Questionnaires

BACKGROUNDMicroendoscopic discectomy (MED) is a minimally invasive operation that allows rapid recovery from surgery for lumbar disc herniation, but has replaced traditional open surgery in few hospitals because most surgeons avoid its long learning curve. We evaluated the effectiveness and safety of lumbar MED at stages of spinal surgeons' learning curve.

METHODSFifty patients receiving MED from June 2002 to February 2003 were divided into chronological groups of ten each: A - E. The control group F was ten MED patients treated later by the same medical team (September - October 2006). All operations were performed by the same team of spinal surgeons with no MED experience before June 2002. We compared groups by operation time, blood loss, complications and need for open surgery after MED failure.

RESULTSOperation times by group were: A, (107 +/- 14) minutes; B, (85 +/- 13) minutes; C, (55 +/- 19) minutes; D, (52 +/- 12) minutes; E, (51 +/- 13) minutes; and F, (49+/- 15) minutes. Blood loss were: A, (131 +/- 73) ml; B, (75 +/- 20) ml; C, (48 +/- 16) ml; D, (44 +/- 17) ml; E, (45 +/- 18) ml; and F, (45 +/- 16) ml. Both operation time and blood loss in groups C, D, E and F were smaller and more stable compared with groups A and B. Japanese Orthopedic Association assessment (JOA) score of each group in improvement rate immediately and one year after operation were as follows (in percentage): A, (79.8 +/- 8.8)/(89.8 +/- 7.7); B, (78.6 +/- 8.5)/(88.5 +/- 7.8); C, (80.8 +/- 11.3)/(90.8 +/- 6.7); D, (77.7 +/- 11.4)/(88.9 +/- 9.3); E, (84.0 +/- 8.7)/(89.6 +/- 9.0); and F, (77.8 +/- 11.6)/(86.9 +/- 8.4). Groups showed no statistical difference in improvement rates. Complications developed in three patients in group A, two in group B, and none in the other groups.

CONCLUSIONSSpinal surgeons performing MED become proficient after 10 - 20 operations, when their skill becomes fairly sophisticated. Patients' improvement rate is the same regardless of surgeons' phase of learning curve.

Adult ; Diskectomy ; education ; Female ; Humans ; Intervertebral Disc Displacement ; surgery ; Learning ; Lumbar Vertebrae ; surgery ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; education ; Prospective Studies

This study is to investigate the anti-angiogenetic effect of arenobufagin in vitro and in vivo. The anti-proliferation effect of arenobufagin on CNE-2, Hep2, SH-SY5Y, LOVO, PC-3 and DU145 cells as well as human umbilical vein endothelial cells (HUVECs) was determined by MTT assay. Cell morphological changes of LOVO and HUVECs after arenobufagin treatment were observed by microscopy. Arenobufagin inhibited the proliferation of CNE-2, Hep2, SH-SY5Y, LOVO, PC-3, DU145 and HUVECs in a dose-dependent manner. Furthermore, it was obviously observed that the subcytotoxic concentration of arenobufagin in human carcinoma cells induced a marked decrease in the viability of HUVECs. Chick embryo chorioallantoic membrane (CAM) model was used to detect the anti-angiogenetic effect of arenobufagin in vivo. Arenobufagin significantly suppressed the angiogenesis of CAM. Cell cycle analysis demonstrated that G2/M phase was arrested and the sub-G1 peak appeared with the increase of arenobufagin concentration. PI/Annexin V double staining assay further demonstrated that arenobufagin could induce apoptosis in a dose- and time-dependent manner. Mitochondrial potential collapse detected by flow cytometric analysis was increased after arenobufagin treatment. It also observed that PARP was cleaved to p85 active form by Western blotting. Taken together, arenobufagin has significant anti-angiogenetic effect in vitro and in vivo, and the action mechanisms behind its anti-angiogenesis may be associated with cell cycle arrest and apoptosis of vein endothelial cells.
Angiogenesis Inhibitors ; administration & dosage ; pharmacology ; Animals ; Antineoplastic Agents ; administration & dosage ; pharmacology ; Apoptosis ; Bufanolides ; administration & dosage ; pharmacology ; Cell Cycle ; Cell Line, Tumor ; Cell Proliferation ; drug effects ; Cell Survival ; Chick Embryo ; Chorioallantoic Membrane ; blood supply ; Dose-Response Relationship, Drug ; Human Umbilical Vein Endothelial Cells ; Humans ; Membrane Potential, Mitochondrial ; drug effects ; Neovascularization, Pathologic ; prevention & control ; Poly(ADP-ribose) Polymerases ; metabolism

OBJECTIVETo study the curative effects of the treatment of tibial avulsion fracture of the posterior cruciate ligament with open reduction and steel-wire internal fixation.

METHODSFrom January 2003 to June 2009, 28 patients of tibial avulsion fracture of the posterior cruciate ligament were treated with open reduction and steel-wire internal fixation through posteromedial inverted "L" approach. There were 19 males and 9 females with an average age of 35.3 years old ranging from 16 to 55 years. The X-ray examination showed that there were II degree displaced in 10 cases and III degree in 18 patients. The affected lower extremity was put in a controlled hinge knee brace after operation. The patients were asked to do passive extension and flexion of the knee joint with the assistance of a CPM 2 weeks after operation,and allowed to be partial weight-bearing as tolerated with the hinged brace locked in extension if concomitant injuries allowed 4 weeks postoperatively. The brace were removed 6 weeks later.

RESULTSAmong them, 25 patients were followed up for 6 to 24 months with an average of 15 months. The X-ray examination showed satisfactory reduction, and bony union was obtained in all the patients. The Lachman test was negative in all patients. No complications such as malunion or joint stiffness were found. The extension of affected knee was normal and its flexion were (136 +/- 12) degrees. According to Lysholm knee score system,it was preoperatively (41.80 +/- 6.16) and (94.10 +/- 8.26) six months after surgery respectively. Twenty-two cases were excellent, 2 cases good and 1 fair.

CONCLUSIONTreatment of tibial avulsion fracture of the posterior cruciate ligament with open reduction and internal fixation with wires through posteromedial inverted "L" approach is a safe, effective method, due to its stable fixation and relatively low expense. It is believed as an ideal choice for tibial avulsion fracture of the posterior cruciate ligament.

Adolescent ; Adult ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Male ; Middle Aged ; Posterior Cruciate Ligament ; diagnostic imaging ; injuries ; physiopathology ; surgery ; Tibial Fractures ; diagnostic imaging ; physiopathology ; surgery ; Tomography, X-Ray Computed ; Treatment Outcome ; Young Adult