Objectives:To clarify the biomechanical stress rebalancing mechanism at the bone tissue-cement interface and the dynamic stability reconstruction effect on the spine after cement reinforcement treatment of osteoporotic vertebral compression fractures(OVCF).Methods:An OVCF patient(injured vertebrae,T12 and L1)treated in the Department of Spine Surgery of the Affiliated Hospital of Gansu University of Traditional Chinese Medicine was selected as the object of study,and thin-layer,high-precision thoracic and lumbar vertebral CT imaging data of the patient was extracted.A 3D digitally simulated biomechanical model was established through the finite-element biomechanical modeling platforms of Mimics,Geomagic,Solidworks,and Ansys Workbench,in order to quantitatively study the equivalent stress at bone tissue-cement interface of motion segment of the injured vertebral body under different motion conditions such as axial,flexion,extension,lateral bending,and rotation.Results:The extreme value and distribution range of equivalent stress at the bone tissue-bone cement interface after spinal OVCF were significantly optimized compared with those before surgery.Under the motion conditions of axial,forward flexion,posterior extension,lateral bending and rotation conditions,the maximum principal stress after spinal cement reinforcement for T12 vertebra decreased significantly compared with that before surgery,which was 33.002MPa,35.639MPa,35.98MPa,60.458MPa,65.396MPa,60.177MPa,and 42.249MPa under the same working conditions,especially under the forward flexion working conditions,the maximum principal stress of T12 decreased from 77.995MPa before surgery to 35.639MPa after surgery;Under the same motion conditions,the maximum principal stress of L1 vertebra after reinforcement treatment was 24.91 1MPa,34.705MPa,26.514MPa,60.144MPa,32.797MPa,30.259MPa,and 32.894MPa,respectively,and under axial and foiward flexion conditions,the maximum principal stress of L1 vertebra decreased from 74.798MPa and 99.232MPa before surgery to 24.911 MPa and 34.705MPa after surgery.The maximum principal stress at T12 and L1 bone cement interface distributed evenly.The extreme value of principal stress at T12 cancellous bone was 1.004MPa to 3.0758MPa,which at L1 cancellous bone was 1.8075MPa to 2.3355MPa.The stress distribution cloud map showed that the stress distribution at hone interface shifted to the middle and posterior columns after the reinforcement treatment,and the stress concentration was corrected.The stress distribution at the bone tissue-bone cement interface tended to be balanced and stabilized.Conclusions:The dynamic biomechanical stability of the spine is reconstructed after cemented reinforcement of the injured vertebrae in the thoracolumbar segment,and the biomechanical stress-strain stimulus at the bone tissue-cement interface is significantly decreased compared with the preoperative period,and the stresses are distributed evenly,which reconstruct the stress rebalancing at the bone tissue-cement interface.

Objective: Transanal total mesorectal excision (taTME) was a very hot topic in the first few years since its appearance, but now more introspections and controversies on this procedure have emerged. One of the reasons why the Norwegian Ministry of Health stopped taTME was the high incidence of postoperative anastomotic leak. In current study, the incidence and risk factors of anastomotic leak after taTME were analyzed based on the data registered in the Chinese taTME Registry Collaborative (CTRC). Methods: A case-control study was carried out. Between November 15, 2017 and December 31, 2020, clinical data of 1668 patients undergoing taTME procedure registered in the CTRC database from 43 domestic centers were collected retrospectively. After excluding 98 cases without anastomosis and 109 cases without complete postoperative complication data, 1461 patients were finally enrolled for analysis. There were 1036 males (70.9%) and 425 females (29.1%) with mean age of (58.2±15.6) years and mean body mass index of (23.6±3.8) kg/m(2). Anastomotic leak was diagnosed and classified according to the International Study Group of Rectal Cancer (ISREC) criteria. The risk factors associated with postoperative anastomotic leak cases were analyzed. The impact of the cumulative number of taTME surgeries in a single center on the incidence of anastomotic leak was evaluated. As for those centers with the number of taTME surgery ≥ 40 cases, incidence of anastomic leak between 20 cases of taTME surgery in the early and later phases was compared. Results: Of 1461 patients undergoing taTME, 103(7.0%) developed anastomotic leak, including 71 (68.9%) males and 32 (31.1%) females with mean age of (59.0±13.9) years and mean body mass index of (24.5±5.7) kg/m(2). The mean distance between anastomosis site and anal verge was (2.6±1.4) cm. Thirty-nine cases (37.9%) were classified as ISREC grade A, 30 cases (29.1%) as grade B and 34 cases (33.0%) as grade C. Anastomotic leak occurred in 89 cases (7.0%,89/1263) in the laparoscopic taTME group and 14 cases (7.1%, 14/198) in the pure taTME group. Multivariate analysis showed that hand-sewn anastomosis (P=0.004) and the absence of defunctioning stoma (P=0.013) were independently associated with anastomotic leak after taTME. In the 16 centers (37.2%) which performed ≥ 30 taTME surgeries with cumulative number of 1317 taTME surgeries, 86 cases developed anastomotic leak (6.5%, 86/1317). And in the 27 centers which performed less than 30 taTME surgeries with cumulative number of 144 taTME surgeries, 17 cases developed anastomotic leak (11.8%, 17/144). There was significant difference between two kinds of center (χ(2)=5.513, P=0.019). Thirteen centers performed ≥ 40 taTME surgeries. In the early phase (the first 20 cases in each center), 29 cases (11.2%, 29/260) developed anastomotic leak, and in the later phase, 12 cases (4.6%, 12/260) developed anastomotic leak. The difference between the early phase and the later phase was statistically significant (χ(2)=7.652, P=0.006). Conclusion: The incidence of anastomotic leak after taTME may be reduced by using stapler and defunctioning stoma, or by accumulating experience.
Adult ; Aged ; Anastomotic Leak/etiology* ; Case-Control Studies ; China/epidemiology* ; Female ; Humans ; Incidence ; Laparoscopy ; Male ; Middle Aged ; Postoperative Complications/epidemiology* ; Rectal Neoplasms/surgery* ; Rectum/surgery* ; Retrospective Studies ; Risk Factors

The Mycoplasma hominis infection is a rare postoperative complication after joint replacement. Based on our knowledge, there were only two cases reported by Korea all over the world currently. A case of postoperative Mycoplasma hominis infection after total knee replacement in our hospital was reported in this article. It was confirmed through mass spectrometer and Mycoplasma cultivation and treated by the first stage debridement, polyethylene insert replacement, and then drainage and irrigation combined with sensitive antibiotics after the operation. We observed that the C reactive protein (CRP) level correlates with the development of disease, while the erythrocyte sedimentation rate (ESR) remains at a high level, indicating the relevance between the Mycoplasma hominis infection caused by knee joint replacement and CRP. This study aims to report the case and review relevant literature.

Objective: To search for an optimal strategy for the treatment of penile and scrotal gangrene by analyzing the clinical effect of vacuum sealing drainage (VSD) as an adjuvant treatment on this disease. METHODS: We retrospectively analyzed the clinical data about 4 cases of penile and scrotal gangrene treated by VSD as an adjuvant treatment from January 2015 to June 2016. The 4 patients all underwent early extensive and radical debridement of gangrene of the scrotum and penis and received intravenous injection of two broad-spectrum antibiotics, followed by VSD for wound drainage and irrigation. RESULTS: Adequate wound drainage was achieved in all the 4 cases, the gangrene range rapidly localized and testicular necrosis avoided. The wound surface healed satisfactorily after cleansing and suturing. The patients were followed up for 3 months after discharged from the hospital and none experienced recurrence. CONCLUSIONS VSD combined with early adequate debridement can effectively localize the gangrene range, significantly reduce the frequency of changing dressings and shorten the hospitalization time of the patient, and therefore is a very effective adjuvant treatment of penile and scrotal gangrene.
Debridement ; Gangrene ; therapy ; Genital Diseases, Male ; pathology ; prevention & control ; therapy ; Humans ; Male ; Negative-Pressure Wound Therapy ; methods ; Penis ; pathology ; Retrospective Studies ; Scrotum ; pathology ; Testis ; pathology ; Treatment Outcome ; Vacuum

PURPOSETo enhance the awareness of rare complications of pelvic fracture and describe the correct diagnosis and effective treatment.

METHODSA total of 188 cases of pelvic fractures were retrospectively reviewed, and four patients who suffered from four types of rare pelvic fracture complications were described, namely ureteral obstruction caused by retroperitoneal hematoma-induced abdominal compartment syndrome (ACS), bowel entrapment, external iliac artery injury, and open scrotal sac injury.

RESULTSWe demonstrated that combined measures should be employed to prevent the occurrence of ACS following major pelvic fractures. Ureteral catheter support may be a good option at an early stage when ACS occurred. Contrasted computed tomography examination and sufficient awareness are keys to a correct diagnosis of bowel entrapment following pelvic fractures. Recognition of risk factors, early diagnosis, and prompt treatment of suspected injury of the external iliac artery are keys to patient survival and to avoid limb loss. Scrotal and/or testicular injury complicated by pelvic fractures should be carefully treated to maintain normal gonad function. Additionally, establishment of a sophisticated trauma care system and multi-disciplinary coordination are important for correct diagnosis and treat- ment of rare complications in pelvic fractures.

CONCLUSIONSRare complications of pelvic fractures are difficult to diagnose and negatively impact outcome. Recognition of risk factors and sufficient awareness are essential for correct diagnosis and prompt treatment.

Adult ; Female ; Fractures, Bone ; complications ; Humans ; Iliac Artery ; injuries ; Intra-Abdominal Hypertension ; diagnosis ; therapy ; Male ; Middle Aged ; Pelvic Bones ; injuries ; Scrotum ; injuries ; Testis ; injuries ; Tomography, X-Ray Computed

Zearalenone (ZEA) is a nonsteroidal estrogen-like mycotoxin widely distributed in maize, wheat, rice and other cereals with its derivants. It also presents in meat or dairy products or even in the aquatic ecosystem via rain, and thus can affect human health. ZEA affects the body function in various ways. On the one hand, it can disturb the synthesis of estrogen and its combination with the receptor, influence the reproductive ability via the estrogen signaling pathway, and cause the dysfunction of the reproductive systems. On the other hand, it can disturb the synthesis of DNA and proteins and result in lipid peroxidation and cytotoxicity by inducing the apoptosis of germ cells. It is known that exposure to different doses of ZEA can affect the female reproductive system by increasing the apoptosis of germ cells and inducing germ cell prematurity, sexual precocity, endocrine disorder, reproductive cycle disorder, and so on. But studies of its influence on the male reproductive system are relatively rare, especially about its unique male-related action mechanisms. This review presents an overview of the studies on the mechanisms of ZEA affecting male fertility and the phenotype changes in the male reproductive system after exposure to ZEA, hoping to provide some new ideas for the protection of human fertility.

Objective To explore the modification of bionic silk fibroin nerve conduits (SF-NCs) by silk sencin.Methods The innovative SS/SF blended-NCs was fabricated by a vertical sequential cooling thermal induced phase separation (TIPS) processing with SF solution added sericin in proportion,its morphology was observed by Scanning electron microscopy (SEM),X-ray diffraction (XRD) and infrared spectroscopy (FTIR) were used to detect its internal molecular structure.MTT assay was used to quantitatively analyzed the PC12 cells viability co-cultured with the innovative SS/SF-NCs,SEM was used to observe the adhesion and morphology of PC12 cells seeded into the innovative SS/SF,PC12 cells were used to assess the NGF bioactivity released from the SS/SF.Results The SEM results showed that the new fabricated SS/SF-NCs had linearly oriented lamellar-like multiple-channel which distributed evenly,got great changes on the channel microstructure and their mechanical properties had been greatly improved,compared to SF-NCs.The XRD and FTIR results showed that the SS/SF-NCs had the similar internal molecular structure with natural silk.The spaces between parallel lamellar-like channels,porosities and compressive strengths of the SS/SF-NCs decreased with decreasing Sequential freezing temperature.MTT assay results showed that the viability of PC12 cell was better than the control group (P ＜ 0.05).The SEM observation indicated that PC12 cells showed good adhesion and differentiation with neuritis outgrowth during the period of co-culture with the SS/SF-NCs.NGF release from the innovative SS/SF-NCs was prolonged over 4 weeks,and remained bioactive.Conclusion The new fabricated SS/SF-NCs modified though silk sericin,which was highly bionic the structure of peripheral nerve fasciculus,had excellent mechanical properties and could be used as another alternative of artificial nerve conduits.

BACKGROUND:Chronic venous insufficiency is a major health problem worldwide. Clinical treatments include venous valve repair and venous segment containing valve transplantation. However, these are invasive procedures, and the supply of vein containing valves is limited. Significant progress in the fields of tissue engineering and regenerative medicine has been made towards the creation of tissue engineered vascular grafts for the repair of damaged or malformed vessels. It has been reported that using tissue engineering, a tissue engineered vein containing valves constructed with self-derived endothelial cells and al ogeneic acellular matrices can provide the complex physiological valve structure and mechanical stability, but this elicited an immunogenic response.
OBJECTIVE:To create a viable and functional vein containing valves, which has the ability to grow, repair, and imitate natural tissues.
METHODS:Bone marrow mesenchymal stem cells were obtained from Beagle dogs by density gradient centrifugation and adherence methods. Bone marrow mesenchymal stem cells were cultured in vitro. Fol owing isolation and culture the cells were examined using flow cytometry and identified by direct induction towards the osteogenic and adipogenic lineages. We fabricated biodegradable venous scaffold containing valves using the method of injection molding combined with thermal y induced phase separation. Based on the self-made cast, a three-dimensional biodegradable vein scaffold containing valves was constructed from poly(lactic-co-glycolic acid). Morphological structure was tested. Bone marrow mesenchymal stem cells were used as seed cells to be seeded onto the lumen of the tissue engineered vein scaffold containing valves in vitro and then incubated for 2 weeks.
RESULTS AND CONCLUSION:Scanning electron microscopy images showed that the scaffold demonstrated sufficient porosity. Cultured cells expressed mesenchymal cellmarkers, CD44 and CD29, but did not express hematopoietic cellmarkers, CD34 and CD45 at the same time point. Scaffolds were nontoxic to cells and were favorable for the growth and migration of bone marrow mesenchymal stem cells. cells attached on the surface of poly(lactic-co-glycolic acid) scaffolds formed a confluent layer after incubation. The cellular constructs were tested in vitro, and the valve leaflets were functional y capable of opening and closing when stimulated. These results suggested that the tissue engineered vein containing valves have been successful y constructed by using a three-dimensional poly(lactic-co-glycolic acid) scaffold and bone marrow mesenchymal stem cells as seed cells. Tissue engineered vein containing valves is potential y useful for the substitution and regeneration of vein valves.

Background Mitomycin C (MMC) is still irreplaceable until now.While it's current administration method has proved less than effective in the treatment of refractory glaucoma.To construct a MMC sustained release system which can maintain effective concentration and reduce toxicity is important for postoperative scarring regulation after glaucoma filtration surgery.Objective To evaluate the postoperative effect of use PTMC-F127-PTMC thermosensitive hydrogel as a new drug delivery carrier to sustained release MMC in rabbit trabeculactory.Methods Sixty rabbits,aged 10 to 14 weeks,were divided into 5 trabeculectomy groups in accordance with the random number table,including surgery only group,blank PTMC-F127-PTMC group and three sustained groups with 0.1 ml PTMC-F127-PTMC loaded with 0.05,0.10,0.20 g/L MMC injected after surgery.The MMC concentration of anterior chamber aqueous in three sustained release group with 0.1 ml PTMC-F127-PTMC loaded with 0.05,0.1,0.2 g/L MMC injected after surgery were tested by Guangzhou Analysis and Testing Center using high performance liquid chromatograph-mass spectrometer (HPLC-MS).At 3,7 days postoperatively,0.1 ml aqueous humor from 2 random selected rabbits in each group was extracted using 1 ml syringe with 30G needles from corneal limbus.At postoperative 1,3,5,7,10,14,28 days,bleb width and depth were calculated with caliper measurements and height was graded semiquantitatively by slit-lamp examinations,intraocular pressure (IOP) was measured with Tonopen.And corneal endothelial cell densities were examined by corneal endothelial counting before and 28 days after surgery.Sequential sections of the operative region were prepared and stained with hematoxylin and eosin and proliferating cell nuclear antigen (PCNA) after taking off the eyeballs from dead rabbits at 28 days later.Results MMC could be sustained released from PTMC-F127-PTMC hydrogel for more than 20 days.The mean postoperative bleb survival time in trabeculectomy surgery only group,blank hydrogel group and three sustained release groups were (5.3 ± 0.4),(5.5 ± 0.4),(12.2 ± 1.0),(25.1 ± 0.9),(26.7 ± 0.7) days respectively,the difference between each group was significantly (F =123.200,P =0.000).0.05 g/L MMC sustained release group has a better bleb survival time than that of surgery only group and blank hydrogel group (P =0.000).Compared with other groups,0.10 g/L and 0.20 g/L MMC sustained group has the longest bleb survival time (P =0.000),and more obvious IOP downtrending (F=53 010.000,P＜0.01).But the difference between the two groups was not significant.There was no difference in cornea endothelia cells counts between each group and no MMC was detected in aqueous humors.Histopathology test shows that the inflammatory response and fibrosis were lighter in MMC sustained release group,with stronger proliferation inhibition.Conclusions PTMC-F127-PTMC thermosensitive hydrogel can be a new drug delivery carrier to sustained release MMC.Sustain release MMC can extent bleb survival time with low toxicity.

The aim of this study is to investigate the growth and proliferation of bone marrow mesenchymal stem cells (BMSCs) three-dimensionally cultured in Pluronic F-127 gel, in order to explore the cellular compatibility of gel and to investigate the feasibility of BMSCs differentiating into adipocytes in gel. Rat BMSCs were isolated from adult bone marrow, and then cultured and amplified in vitro. The BMSCs derived from the 4th passage were seeded on the scaffolds and incubated in adipogenic stimuli culture to differentiate into adipocytes. BMSCs were dispersed into gel and cultured in vitro for two weeks then the status of adhesion, growth and proliferation of the cells were observed. The edipogenic differentiation of the BMSCs was assessed by cellular morphology and further confirmed by Oil Red O staining. BMSCs were able to attach, grow and proliferate well in Pluronic F-127 gel. The BMSCs differentiated into adipocytes in gel in the presence of adipogenic stimuli over a period of 2 weeks. After only 4 days of adipogenic induction, small lipid droplets were observed within BMSCs in gel wells treated with differentiation media. At the end of 14 days, in the presence of differentiation media in gel, the size of the lipid droplets increased to occupy most of the cytoplasm, consistent with differentiation of BMSCs into adipocytes. Lipid droplets in differentiating BMSCs were positively stained with Oil Red O in the presence of differentiation media in the Pluronic F-127 treatment. We demostrated BMSCs incubated in the 3D Pluronic F-127 gel scaffolds could be induced and differentiated into adipocytes. The system for inducing differentiation of BMSCs into adipocytes is promising to apply in the construction of tissue engineering adipose tissue and the repair of fat injury, and Pluronic F-127 gel may be a suitable scaffold for cellular therapy of BMSCs.
Adipocytes ; cytology ; Adipose Tissue ; cytology ; Animals ; Bone Marrow Cells ; cytology ; Cell Differentiation ; drug effects ; Cells, Cultured ; Hydrogels ; chemistry ; Mesenchymal Stromal Cells ; cytology ; Poloxamer ; chemistry ; Rats ; Rats, Sprague-Dawley ; Tissue Engineering