BACKGROUND: In recent years, acel ular human cadaveric dermis has been applied for repairing dermal defects and fil ing soft tissues, but this repair material is expensive and difficult to obtain. OBJECTIVE: To explore the repair effect of tissue-engineered acel ular dermis on wound healing of skin ulcer. METHODS: Sprague-Dawley rats were randomly divided into autologous reticular dermis and acel ular dermis groups. The tissue-engineered acel ular dermis was prepared by hypotonic solution, 2.5 g/L trypsin, 0.5% Triton X-100 and PBS solution, and in the meanwhile, a rat model of skin ulcer was established. Then, autologous skin graft and tissue-engineered acel ular dermis were transplanted into the autologous reticular dermis group and acel ular dermal group, respectively. Subsequently, comparative study about the repair effect and relative mechanism between two groups was performed. RESULTS AND CONCLUSION: The tissue-engineered acel ular dermis showed a white and grainy shape at room temperature. And hematoxylin-eosin staining showed that: the internal structure of tissue-engineered acel ular dermis exhibited a dendritic distribution, and the gap between col agen fiber bundles was relatively large. At 2, 3, 4 and 8 weeks after dermal transplantation, the survival rate of skin graft in the acel ular dermis group was significantly higher than that in the autologous reticular dermis group (P < 0.05). And the wound contraction rate in the acel ular dermis group was significantly higher than that of the autologous reticular dermis group at 3, 4 and 8 weeks after dermal transplantation (P < 0.05). In addition, the average diameter and clearance rate of col agen fibers in the normal skin around wound in the acel ular dermis group were significantly higher than those of autologous reticular dermis group (P < 0.05). To conclude, it is relatively simple to prepare tissue-engineered acel ular dermis under mild conditions, and the prepared tissue-engineered acel ular dermis presents a regular shape. Moreover, this acel ular dermis achieves desired outcomes in repairing dermal defects, which can promote wound healing by reducing the intradermal DNA residual and significantly improving some biomechanical properties in vivo.

BACKGROUND:An appropriate biomaterial can be directly combined with autologous or al ogeneic skin cel s to construct tissue-engineered skin, which can accelerate skin repair after transplantation onto the skin wounds. It is a good idea to solve the deficiency in skin sources. OBJECTIVE:To study the biological characteristics of the complex with bone marrow mesenchymal stem cel s and to investigate the application of this complex in skin defect repair. METHODS:Twenty-eight Sprague-Dawley rats, SPF grade, were randomized into two groups (n=14 per group). By adjustment of temperature, time, pressure and area of NC perm instrument, scald models were made in rats. Rats in the treatment group were given the repair using composite bone marrow mesenchymal stem cel s, while those in the control group were given vaseline gauze repair. Repair effects were compared between two groups. RESULTS AND CONCLUSION:(1) After 72 hours of culture, the composite bone marrow mesenchymal stem cel s smal with round shape distributed dispersedly. After 5 days of culture, the cel s began to stretch and the cel morphology became unstable. After three passages, the cel morphology became stable. The results of antigen identification showed the expression of CD44 and CD29 but the low expression of CD45 and CD34 in bone marrow mesenchymal stem cel s. (2) Twenty-eight days after repair, there was no obvious scar on the wound surface of the treatment group, but a little shrinkage and obvious scar stil existed in the control group. Moreover, in the control group, the epidermal layer of the skin was relatively thick, and the connection between the basal layer and the dermis was unsatisfactory. In the treatment group, obvious epidermal cel stratification, neat arrangement, and tight connection between the epidermis and dermis were observed. In summary, bone marrow mesenchymal stem cel s are a special class of cel s that have pluripotent ability and are more readily available. These cel s are the preferred target cel s for skin defect repair to promote early healing of the skin and improve blood circulation defect site, which are confirmed to have high clinical value.

OBJECTIVETo retrospectively analyze the influence of preoperative range of motion (ROM) and maximal flexion degree on the early clinical outcome of total knee arthroplasty (TKA).

METHODSFrom January 2000 to December 2003, 97 knees of 65 patients that were underwent total knee arthroplasty with Scorpio posterior-stabilized knee prosthesis were reviewed. There were 55 osteoarthritis patients (81 knees), and 10 rheumatoid arthritis (16 knees). Thirty-three patients were underwent unilateral TKA, 32 patients were underwent bilateral TKA. According to the preoperative ROM of knee, these patients were divided into two groups, one 90 degrees (range, 95 degrees - 140 degrees ). Finally the clinical outcomes of two groups (include ROM, maximal flexion degree, KSS score and function score) were evaluated. Three days later after operation, continuous passive motion (CPM) and active functional exercise of the knee were begun, and the wound healed well in all patients. All these operations were primary total knee arthroplasty.

RESULTSThe patients were followed up for average 2 years 5 months (range, 10 months to 3 years 8 months). The average ROM of knee was improved to 101.6 degrees (range, 40 degrees - 140 degrees ) after operation from 84.2 degrees (range, 5 degrees - 140 degrees ) before operation (P = 0.000); the average maximal flexion degree was decreased from 103.5 degrees (range, 25 degrees - 140 degrees ) before operation to 101.6 degrees (range, 40 degrees - 140 degrees ) after operation (P = 0.439); KSS of knee joint was improved to 78.8 points after operation (range, 50 - 95 points) from 19.5 points (-24 - 62 points) before operation (P = 0.000). There was statistically difference between the clinical outcomes (ROM, maximal flexion degree, KSS score and function score) in the two groups before and after operation. Those knees with good preoperative ROM tend to lose flexion, while those with poor preoperative ROM gain flexion after TKA. No revision and deep infection happened.

CONCLUSIONSTKA is a complex operation, the clinical outcome of TKA is mainly determined by the good operation skill, abundant clinical experience and the familiarity with the prosthesis of the surgeon. At the same conditions such as same surgeon, same prosthesis and same physical therapy, preoperative range of motion of knee influence on the early clinical outcome of total knee arthroplasty, knees that have good preoperative ROM have better clinical outcomes postoperatively than those with poor preoperative ROM.

Adult ; Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Knee ; methods ; Female ; Follow-Up Studies ; Humans ; Knee Joint ; physiopathology ; Knee Prosthesis ; Male ; Middle Aged ; Range of Motion, Articular ; Retrospective Studies ; Treatment Outcome

OBJECTIVETo evaluate the clinical results and perioperative management of primary total knee arthroplasty (TKA) in hemophilic patients.

METHODSFrom February 1997 to February 2006, the data of 6 total knee arthroplasty performed in 4 hemophilic patients was reviewed retrospectively. The values of coagulation factor were maintained at suitable level by monitoring the activity of the factors and their inhibitors during perioperative period. The mean follow-up time was 4.4 years, knee society score and the last postoperative radiographs were recorded.

RESULTSAfter TKA, the hemophilic patients felt pain of knee relieved, the knee function was improved, but the range of motion increased limitedly. At the early post-operative stage, 3 knees in 2 patients with hemarthrosis or muscle bleeding, 1 of the 2 patients complicated with formation of inhibitor of factor VIII and healing problem in 1 knee after TKA, 1 patient with transient paralysis of the common peroneal nerve, 1 patient with venous circulation insufficiency crisis, but no compartment syndrome. In the late stage after TKA, 1 patient with hemarthrosis of both elbows, but no late infection, loosening, displacement and fracture of the prosthesis in the 6 knees.

CONCLUSIONSTotal knee arthroplasty could alleviate knee pain and improve joint function in advanced severe hemophilic arthritic patients. It is important to monitor the activity and inhibitors of coagulation factor VIII or IX, which could decrease the early and late postoperative complications.

Adult ; Aged ; Arthritis ; etiology ; surgery ; Arthroplasty, Replacement, Knee ; Follow-Up Studies ; Hemophilia A ; complications ; Humans ; Male ; Middle Aged ; Perioperative Care ; Retrospective Studies ; Treatment Outcome

OBJECTIVETo explore the effect and the mechanism of Danhong Injection (DI), Ligustrazine Injection (LI), and adsorbable biomembranes in preventing the adhesion of tendons and tissues.

METHODSTotally 120 patients all suffering from simple flexor digitorum tendon rupture on the hand zone two damaged by sharp weapons were randomly assigned to Group A (Dikang adsorbable biomembrane), Group B (Tianxinfu adsorbable biomembrane), Group C (Tianxinfu adsorbable biomembrane + Ligustrazine group), and Group D (Tianxinfu adsorbable biomembrane + DI group) in accordance with random digit table, 30 cases in each group. Indicators such as total active movement (TAM) of the hand tendon, Minnesota manual dexterity test (MMDT), and finger flex strength test (FFST) were observed.

RESULTSThe TAM and the favorable rate were higher in Group C and D than in Group A and B at post-operative 4 and 8 week (P < 0.05, P < 0.01). There was no statistical difference between Group C and D (P > 0.05). Each index of MMDT was lower in Group C and D than in Group A and B (P < 0.05). There was no statistical difference in FFST among all the 4 groups (P > 0.05).

CONCLUSIONSCombined application of LI or DI with Tianxinfu adsorbable biomembranes could effectively prevent the adhesion of tendons. DI showed equivalent effect as LI did. Besides, the combined application was superior in preventing adhesion to using Xintianfu adsorbable biomembrane or Dikan adsorbable biomembrane alone.

Absorbable Implants ; Adult ; Drugs, Chinese Herbal ; administration & dosage ; therapeutic use ; Female ; Humans ; Male ; Membranes, Artificial ; Middle Aged ; Musculoskeletal Diseases ; prevention & control ; Pyrazines ; administration & dosage ; therapeutic use ; Tendon Injuries ; surgery ; Tissue Adhesions ; prevention & control ; Wound Healing

OBJECTIVETo analyze the clinical risk factors for deep vein thrombosis (DVT) after total hip and knee arthroplasty in Chinese patients who received prophylactic treatment for DVT.

METHODSWe evaluated 128 total hip arthroplasty (THA) and total knee arthroplasty (TKA) in 95 patients performed at our center from April 2004 to August 2004, which included 48 THAs in 43 patients and 80 TKAs in 52 patients. There were 27 men and 68 women with a mean age of 59.77 years (range, 23-78 years). All patients had been given low-molecular-weight heparin before operation and for 7-10 days post-operation to prevent DVT. Color Doppler ultrasonography was used to detect DVT of bilateral lower extremities in all patients before operation and at 7-10 days after operation. Nineteen clinical factors were examined preoperation and 7-10 days post-operation in order to analyze their influences on DVT formation after surgery.

RESULTSThere were 45 patients who developed DVT after operation. The incidence of DVT in all patients was 47.4% (45/95) and the incidence of proximal DVT was 3.2%. There were more asymptomatic DVT (57.8%, 26/45) than symptomatic ones, and some patients without DVT (14%, 7/50) presented some of the DVT symptoms. Logistic regression analysis demonstrated a definite association of female, obesity (representative by BMI), cement usage and diagnosed RA with DVT with odds ratio of 10.008, 3.094, 8.887, and 0.194 respectively. Other clinical factors had no statistically significant association with DVT.

CONCLUSIONSFemale, obesity, and cement usage were the risk factors for DVT after THA and TKA, and diagnosed RA was the protecting factors for DVT after THA and TKA. Other clinical factors such as age, OA, type of implant, monolateral or bilateral operation, duration of anesthesia, surgery and bandage usage for blood control, time for immobilization et al were not the risk factors for DVT.

Adult ; Aged ; Arthritis, Rheumatoid ; Arthroplasty, Replacement, Hip ; adverse effects ; Arthroplasty, Replacement, Knee ; adverse effects ; Bone Cements ; adverse effects ; Female ; Humans ; Male ; Middle Aged ; Obesity ; Postoperative Complications ; prevention & control ; Retrospective Studies ; Risk Factors ; Sex Factors ; Thrombophlebitis ; etiology ; prevention & control

OBJECTIVETo investigate the methods and clinical results of total knee replacement (TKA) in patients with valgus knee deformity.

METHODSBetween January 1996 and August 2004, 87 TKAs were performed by means of medial parapatellar approach, standard osteotomy and only lateral soft tissue release with posterior stabilized implants on 74 patients (11 men and 63 women) with valgus deformity. The average age at the time of operation was 62.93 years (range, 26-80 years). Clinical and radiographic evaluations including range of motion (ROM), Knee Society Score System (KSS) and the tibial and femur angle (T-F angle) were performed at follow-up.

RESULTSAfter a mean follow-up of 33.8 months (range, 5 months-9 years), the average ROM improved from 91 degrees (range, 70 degrees-120 degrees) preoperatively to 112.4 degrees (range, 80 degrees-130 degrees) postoperatively, the average KSS improved from 22.7 points (0-48 points) preoperatively to 81.7 points (range, 71-93 points) postoperatively. The average function score improved from 26.5 points preoperatively to 86.3 points postoperatively, the average T-F angle was corrected from 21.59 degrees (range, 12 degrees-40 degrees) of valgus preoperatively to 8.7 degrees (0 degrees-11 degrees) of valgus postoperatively. One knee had lightly instability at follow-up, one knee with patellar dislocation preoperatively had subdislocation postoperatively, no other complication occurred.

CONCLUSIONSThe techniques of medial parapatellar approach, standard osteotomy and only lateral soft tissue release with posterior stabilized implants can correct a fixed valgus deformity very successfully in patients undergoing primary total knee replacement, and provides excellent results.

Adult ; Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Knee ; methods ; Female ; Follow-Up Studies ; Humans ; Joint Deformities, Acquired ; surgery ; Knee Joint ; surgery ; Knee Prosthesis ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome

BACKGROUNDProgrammed cell death 5 (PDCD5) is a novel apoptotic regulatory gene that promotes apoptosis in various tumor cells. Studies have shown that PDCD5 accelerates the apoptosis of synoviocytes in vitro, implying a potential role in rheumatoid arthritis (RA) pathogenesis. This study examined the expression of PDCD5 in serum and synovial fluid of RA patients, its effect on the expression of inflammatory cytokine, interleukin-17 (IL-17), and the assessment of disease activity in RA.

METHODSPDCD5 and IL-17 levels in serum and synovial fluid from 18 patients with RA and 22 patients with osteoarthritis (OA) were detected using enzyme-linked immunosorbent assay (ELISA). Concentrations of serum PDCD5 in 40 healthy people were also detected as controls. As disease activity indices, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), rheumatoid factor (RF), and X-ray grading scale were also evaluated.

RESULTSSerum and synovial fluid PDCD5 levels in RA patients were significantly higher than those in OA and healthy controls. Serum PDCD5 level was inversely correlated to CRP and ESR, and was significantly higher in the RF negative group than in the positive group. PDCD5 level was also negatively correlated with IL-17 levels both in serum and synovial fluid of RA patients. However, differences in synovial fluid PDCD5 level from RA patients at different Larsen stages were not detectable.

CONCLUSIONSPDCD5 affects RA pathogenesis. Insufficient apoptosis of fibroblast-like synoviocytes and inflammatory cells in RA could increase the expression of PDCD5 protein. As PDCD5 levels correlated negatively with disease activity indices and IL-17 level, PDCD5 could become a target in the diagnosis and treatment of RA.

Aged ; Apoptosis ; Apoptosis Regulatory Proteins ; analysis ; blood ; physiology ; Arthritis, Rheumatoid ; etiology ; Blood Sedimentation ; C-Reactive Protein ; analysis ; Female ; Humans ; Interleukin-17 ; analysis ; blood ; physiology ; Male ; Middle Aged ; Neoplasm Proteins ; analysis ; blood ; physiology ; Synovial Fluid ; chemistry

OBJECTIVETo discuss the outcomes and complications of total knee arthroplasty (TKA) for extension ankylosing deformity of the knee.

METHODSFrom January 1996 to June 2006, total knee arthroplasty was performed on 8 patients (9 knees) with extension ankylosing deformity. The preoperative ROM of all patients was 0 degrees . Preoperative knee and function score of KSS were 44 points (from 10 to 68) and 17 points (from -10 to 55) respectively.

RESULTSThe complications of all TKAs included patellar tendon avulsion in 1 knee, partial fracture of inferior patella in 1 knee, hematoma in 1, superficial infection in 1. All patients were followed up for an average of 40.4 months (from 7.0 to 120.0). The average postoperative ROM was 89 degrees (from 50 degrees to 120 degrees ). Postoperative knee and function score of KSS were 81 points (from 55 to 93) and 79 points (from 50 to 90) respectively. Extension lag occurred in 2 knees, one was 10 degrees and the other was 25 degrees . One knee had undergone re-revision of changing the thicker tibial spacer for the reason of instability of joint 1 year after revision.

CONCLUSIONSTKA performed in extension ankylosing deformity can get less satisfactory clinical results comparing with fixed flexion deformity. Exposure of the knee joint and separation of the fused bones, providing a mobile joint space plays crucial procedure for the next step of surgery. Preservation of sufficient bone stock of patella, protection of patellar tendon and blood supply of the knee and proper soft tissue balance are the key to TKA for extension ankylosing deformity.

Adult ; Aged ; Ankylosis ; physiopathology ; surgery ; Arthroplasty, Replacement, Knee ; adverse effects ; methods ; Female ; Humans ; Joint Deformities, Acquired ; physiopathology ; surgery ; Knee Joint ; Male ; Middle Aged ; Postoperative Complications ; prevention & control ; Range of Motion, Articular ; Retrospective Studies ; Treatment Outcome

Objective: To investigate the expression of ALC1 protein during esophageal squamous cell carcinoma (ESCC) development and progression, so as to explore its association with clinicopathological characteristics and overall survival of ESCC patients, and the effect of ALC1 overexpression on malignant biological behavior of esophageal squamous cells. Methods: Immunohistochemistry (IHC) was used to detect ALC1 protein expression in 245 primary ESCC tissues and their paired normal esophageal mucous membranes, and to determine its correlation to gender, age, tumor cell differentiation, invasion, TNM stage, lymph nodes metastasis, and overall surviv-al rate of ESCC patients. MTT assay, colony formation assay, transwell invasion, and wound healing assay were used to observe the ef-fect of ALC1 on ESCC cell proliferation, invasion, and migration. Results: The expression ratio of ALC1 in esophageal squamous cell car-cinoma was higher compared with that in their paired normal esophageal mucous membranes (41.6% vs . 21.2% , P<0.05). Upregula-tion of ALC1 was associated with ESCC invasion, TNM stage, and lymph node metastasis (P<0.05). The overall survival of ESCC patients with ALC1 overexpression was significantly lower than that in patients with downregulated ALC1 expression (P=0.002). Therefore, ALC1 may promote the proliferation, invasion, and migration of ESCC cells. Conclusions: ALC1 upregulation may play an important role in the progression and development of ESCC. Upregulation of ALC1 leads to poorer disease prognosis, and could promote the prolifera-tion, invasion, and migration of the KYSE30 ESCC cells. Therefore, ALC1 may have potential prognostic value for ESCC patients.