Distal humerus fractures require stable fixation and early joint motion, similar to other intra-articular fractures, but are difficult to treat adequately because of the anatomical complexity, severe comminution, and accompanying osteoporosis. In most cases, surgical treatment is performed using two supporting plates. Plate fixation can be divided into right angle plate fixation and parallel plate fixation. In addition, depending on the type of fracture, surgical procedures can be performed differently, and autologous bone grafting can be required in the case of severe bone loss. The elbow joint is vulnerable to stiffness, so it is important to start joint movement early after surgery. Postoperative complications, such as nonunion, ulnar nerve compression, and heterotopic ossification, can occur. Therefore, accurate and rigid fixation and meticulous manipulation of soft tissues are required during surgery.
Bone Transplantation ; Elbow Joint ; Humerus ; Intra-Articular Fractures ; Joints ; Ossification, Heterotopic ; Osteoporosis ; Postoperative Complications ; Rehabilitation ; Ulnar Nerve ; Ulnar Nerve Compression Syndromes

Total thyroidectomy is increasingly accepted for the management of bilateral benign thyroid disorders. Postoperatively, patients require lifelong levothyroxine replacement therapy to avoid postoperative hypothyroidism, which besides the burden of compliance, has been proven to be associated with several long-term side effects. Heterotopic thyroid autotransplantation was proposed several decades ago to avoid the need for life-long postoperative replacement therapy with maintaining the autoregulatory mechanism of thyroxin production inside the body according to its needs. Available data regarding this topic in literature is relatively poor. Before applying thyroid autotransplantation on humans, several studies have been done on animals, where the autologous transplantations were found to be successful in almost all the cases, proved by follow up postoperative 8-week measurements of thyroid hormones and histopathological examination of the removed autografts. Regarding the clinical application, few trials have been done using cryopreserved in vivo, in vitro or immediately autotransplanted thyroid autografts. Satisfactory results were obtained, however, the number of these studies and the number of patients per each study was very low. Besides the study methodologies were not so consistent.
Animals ; Autografts* ; Compliance ; Follow-Up Studies ; Humans ; Hypothyroidism ; In Vitro Techniques ; Thyroid Gland* ; Thyroid Hormones ; Thyroidectomy ; Thyroxine ; Transplantation, Autologous* ; Transplantation, Heterotopic

OBJECTIVETo establish stoma and stoma-free murine models of heterotopic small intestine transplantation in order to choose a more effective and reliable model.

METHODSA total of 140 male 8-10 weeks age C57BL/6(B6) mice weighted 25-30 g were enrolled in the experiment. Syngeneic heterotopic small intestine transplantation was performed between C57BL/6 mice, and recipient mice were divided into either stoma or stoma-free group. Heterotopic small intestine transplantation was performed in 70 mice, with 35 mice in each group. After closing the proximal end of the graft by ligation, the distal end of graft was exteriorized as a stoma then secured to the skin of the abdominal wall in stoma group. In stoma-free group, the distal end of graft was anastomosed end-to-side to the recipient ileum. Successful rate of operation, two-week survival rate, operation time, associated complications, postoperative care time and body weight change were recorded and compared between two groups.

RESULTSThe successful rate of stoma group was 65.7%, while it was 80.0% of stoma-free group (χ(2)=1.806, P=0.179). The operation time of donor in stoma group was (48.1±6.6) minutes, while it was (47.2±5.9) minutes in stoma-free group (t=0.598, P=0.552). The operation time of recipient in stoma group was (77.9±9.1) minutes, while it was (76.4±8.3) minutes in stoma-free group (t=0.683, P=0.497). The cold ischemic time of graft in stoma group was (34.7±4.0) minutes, while it was (33.9±4.6) minutes in stoma-free group(t=0.667, P=0.507). The two-week survival rate of stoma group was 45.7%, and it was 77.1% of stoma-free group(χ(2)=7.295, P=0.007). The stoma group had more complications[54.3%(19/35) vs. 22.9%(8/35), χ(2)=7.295, P=0.007], which needed more postoperative care time(191 min vs. 35 min). The weight loss in stoma group in the third day after operation was more significant [(81.52±5.20)% vs. (85.46±4.65)%, t=2.856, P=0.006]. By 2 weeks after operation, the weight of mice in both groups retruned to 95% of the postoperative wight.

CONCLUSIONThe murine heteropotic small intestine transplantation model with stoma-free appears to be more reasonable and reliable.

Animals ; Digestive System Surgical Procedures ; Ileum ; surgery ; Intestine, Small ; transplantation ; Male ; Mice ; Mice, Inbred C57BL ; Surgical Stomas ; Transplantation, Heterotopic ; methods ; Transplantation, Isogeneic

BACKGROUNDRe-epithelialization has remained a major obstacle in both tracheal and lung transplantations. This study examines the realization of re-epithelialization by epithelial inoculation in a rat heterotopic tracheal transplantation model.

METHODSThe original epithelia of tracheas from donor Wistar rats were removed and the tracheas were then inoculated with 10(6)/ml in vitro cultured epithelial cells of the Spraque-Dawley (SD) rat phenotype. These allo-tracheas were then heterotopically transplanted into SD rats. After 28 days, the allo-trachea tissues were recovered and assessed for epithelial morphology and cellular differentiation using immunohistochemical analysis. An additional experimental group was used to compare the outcomes of re-epithelialization in immunosuppressed animals.

RESULTSHistological examination showed that allografts with epithelial inoculation maintained patent tracheal lumens, which were obliterated in controls. Recipient immunosuppression facilitated the formation of an integrated ciliated epithelial layer, further demonstrated by the presence of a dense cilia population, a well-developed plasma membrane, and readily recognizable intercellular junctions. Epithelial cellular differentiation markers such as cytokeratin 14 and 18, and cystic fibrosis transmembrane conductance regulator (CFTR) were all positive in allografts under immunosuppression.

CONCLUSIONConcurrent recipient-derived epithelial inoculation with immunosuppression can result in complete re-epithelialization with the recipient phenotype and suppress the luminal obliteration process in heterotopic transplantations.

Allografts ; cytology ; Animals ; Bronchiolitis Obliterans ; surgery ; Epithelial Cells ; cytology ; Female ; Male ; Rats ; Rats, Sprague-Dawley ; Rats, Wistar ; Trachea ; cytology ; transplantation ; Transplantation, Heterotopic

This paper is aimed to establish a novel abdominal heart transplantation model in mice and to generalize the experience of the successful cases. The thoracic inferior vena cava instead of pulmonary artery was employed to reconstruct the outflow tract of the graft heart (in the new method group, 82 cases). Meanwhile, in other 47 cases as the control group, traditional anastomosis was used between pulmonary artery of the graft and vena cava of the recipient. The recipient surgery time, vena cava-vena cava anastomosis time, graft cold ischemia time and graft re-beating time were (41.5 +/- 1. 5) min, (8.4 +/- 0.6) min, (32.3 +/- 0.4) min and (1.5 +/- 0.2) min respectively. All the above data were statistically superior to those in the traditional method group (P < 0.001 or P < 0.05). The survival rate of 100 d post surgery in the new method group was 93. 9%. Meanwhile, the cardiac tissue remained almost normal examined by HE and Picro-sirus red staining. Therefore, the novel model can facilitate the anastomosis of the outflow tract in recipient operation in mouse heart transplantation model.
Anastomosis, Surgical ; methods ; Animals ; Heart Transplantation ; methods ; Male ; Mice ; Mice, Inbred C57BL ; Models, Animal ; Peritoneal Cavity ; Pulmonary Artery ; surgery ; Transplantation, Heterotopic ; methods ; Vena Cava, Inferior ; surgery

OBJECTIVE: To elucidate etiological factors of heterotopic ossification (HO) by evaluating retrospectively if HO is a unique finding following cervical total disc replacement (CTDR) or a finding observable following an anterior cervical interbody fusion (ACIF). METHODS: The authors had selected 87 patients who underwent anterior cervical surgery (TDR or ACIF), and could be followed up more than 24 months. A cervical TDR was performed using a Bryan disc or a ProDisc-C and an ACIF using a stand-alone cage or fibular allograft with a plate and screws system. The presence of HO was determined by observing plain radiography at the last follow up. The relation between HO occurrence and specific preoperative radio-logical findings (osteophyte and calcification of posterior longitudinal ligament (PLL)) at the index level was investigated. RESULTS: Cervical TDR was performed in 40 patients (43 levels) and ACIF in 47 patients (54 levels). At the final radiographs, HO was demonstrated at 27 levels (TDR-Bryan; 8/18, TDR-Prodisc-C; 12/25, ACIF-cage alone; 7/29, and ACIF-plate screw; 0/25). Mean ROM at the last follow-up of each TDR subgroup were 7.8+/-4.7degrees in Bryan, 3.89+/-1.77degrees in Prodisc-C, and it did not correlated with the incidence of HO. Fusion status of ACIF groups was observed as 2 case of grade 1, 6 of grade 2, and 21 of grade 3 in cage alone subgroup, and no case of grade 1, 4 of grade 2, and 21 of grade 3 in plate screw subgroup. Fusion status in ACIF-cage alone subgroup was significantly related to the HO incidence. The preoperative osteophyte at the operated level observed in 27 levels, and HO was demonstrated in 12 levels (TDR-Bryan; 3/5, TDR-Prodisc-C; 2/3, ACIF-cage alone; 7/11, and ACIF-plate screw; 0/8). Preoperative PLL calcification at the operated level was observed 22 levels, and HO was defined at 14 levels (TDR-Bryan; 5/5, TDR-Prodisc-C; 4/5, ACIF-cage alone; 5/7, and ACIF-plate screw; 0/5). The evidence of preoperative osteophyte and PLL calcification showed statistically significant relations to the occurrence of HO. CONCLUSION: HO was observed in both TDR and ACIF groups. HO was more frequently occurred in TDR group regardless of prosthesis type. In ACIF group, only cage alone subgroup showed HO, with relation to fusion status. Preoperative calcification of longitudinal ligaments and osteophyte were strongly related to the occurrence of HO.
Cinnarizine ; Follow-Up Studies ; Humans ; Incidence ; Longitudinal Ligaments ; Ossification of Posterior Longitudinal Ligament ; Ossification, Heterotopic ; Osteophyte ; Prostheses and Implants ; Retrospective Studies ; Total Disc Replacement ; Transplantation, Homologous

BACKGROUND: The results after acetabular fracture are primarily related to the quality of the articular reduction. We evaluated the results of internal fixation of posterior wall fractures with using three-step reconstruction. METHODS: Thirty-three patients (mean age at the time of injury, 47.9 years; 28 males and 5 females) were followed for a minimum of 2 years after surgery. The three-step reconstruction included 1) preservation of soft tissues and reduction of the marginally impacted osteochondral (articular) fragments using screws, 2) filling the impacted cancellous void with a bone graft, and 3) reinforcement with buttress-plating. Clinical evaluation was done according to the criteria of D'aubigne and Postel, while the radiological criteria were those of Matta. The associated injuries and complications were evaluated. RESULTS: The clinical results were excellent in 15 (45.5%) patients and they were good in 5 (15.2%), (i.e., satisfactory in 60.7%), while the radiologic results were excellent in 10 (30.3%) and good in 14 (42.4%) (satisfactory in 72.7%). Heterotopic ossification was common, but this did not require excision, even without prophylactic treatment with indomethacin. Deep infection was the worst complication and this was accompanied by a poor outcome. CONCLUSIONS: This study confirms that three-step reconstruction facilitates accurate and firm reduction of displaced posterior wall fractures of the acetabulum. Therefore, we anticipate less long-term arthrosis in the patients treated this way.
Acetabulum/*injuries/radiography/*surgery ; Adult ; Aged ; Bone Plates ; Bone Screws ; Bone Transplantation ; Female ; Fracture Fixation, Intramedullary/*methods ; Fractures, Bone/radiography/*surgery ; Humans ; Male ; Middle Aged ; Ossification, Heterotopic ; Surgical Wound Infection ; Treatment Outcome ; Young Adult

Although the liver is the most common site for pancreatic islet transplantation, it is not optimal. We compared kidney, liver, muscle, and omentum as transplantation sites with regard to operative feasibility, and the efficiency of implantation and glycemic control. Islets from C57BL/6 mice were transplanted into diabetic syngeneic recipients. The mean operative time and mortality were measured to assess feasibility. To assess implantation efficiency, the marginal mass required to cure diabetes and the mean time taken to achieve normoglycemia were measured. A glucose tolerance test was performed to assess glycemic control efficiency. The data are listed in the order of the kidney, liver, muscle, and omentum, respectively. The mean mortality rate was 6.7, 20.0, 7.1, and 12.5%; the mean operative time was 10.2, 27.4, 11.2, and 19.8 min; the marginal islet mass was 100, 600, 600, and 200 islet equivalence units and the mean time to reach euglycemia was 3.0, 15.1, 26.6, and 13.9 days. The glucose kinetics of omental pouch islets was the most similar to controls. Thus, a strategic approach is required for deciding on the best transplantation recipient sites after considering donor sources and islet volume. Alternatives can be chosen based on safety or efficacy.
Animals ; Blood Glucose/analysis ; Diabetes Mellitus, Experimental/chemically induced/mortality ; Glucose Tolerance Test ; Hyperglycemia/therapy ; *Islets of Langerhans Transplantation ; Kidney ; Liver ; Mice ; Mice, Inbred C57BL ; Muscle, Skeletal ; Omentum ; *Transplantation, Heterotopic

OBJECTIVETo investigate the effect and mechanism of FTY720 on acute graft versus host disease (GVHD) in rat small bowel transplantation (SBTx).

METHODSHeterotopic SBTx was performed using a parent (WF)-into-F1 (WFxACI) rat combination. Recipient rats were divided into experimental group (n=6) and control group (n=6). Rats in the experimental group were administered with FTY720 at 0.5 mg/kg for 14 days. Lymphocyte apoptosis in the liver and the mucosa of intestine and graft was detected by TUNEL and flow cytometry 15 days after transplantation. Recipient survival and lymphocyte apoptosis were compared between the two groups.

RESULTSRecipients in the control group died of GVHD after a mean survival time of (16+/-2.1) days. FTY720-treated recipients had a significantly longer survival (>100 days). After administration of FTY720, the percentage of apoptotic lymphocytes was significantly increased in the graft as compared to that in the control group by flow cytometry. The ratio of apoptotic lymphocyte in the liver and graft was also significantly higher in the experimental group by TUNEL.

CONCLUSIONFTY720 effectively induces the lymphocyte apoptosis, inhibits the lesion of target tissues by GVHD, and prolongs the recipient survival.

Animals ; Apoptosis ; drug effects ; Fingolimod Hydrochloride ; Graft vs Host Disease ; immunology ; prevention & control ; Immunosuppressive Agents ; pharmacology ; Intestine, Small ; transplantation ; Lymphocytes ; cytology ; drug effects ; Male ; Propylene Glycols ; pharmacology ; Rats ; Rats, Inbred WF ; Sphingosine ; analogs & derivatives ; pharmacology ; Transplantation, Heterotopic

AIMTo investigate the relationship between the expression of MMP-2, MMP-9, TIMP-1 and TIMP-2 and ECM accumulation in rat left ventricle in a mechanical unloaded heart model.

METHODS12-week-old male Lewis rats were subjected to abdominal heterotopic heart transplantation to achieve pressure and volume unloading(mechanical unloading). Age and sex matched in situ heart of Lewis rats were used as control. Collagen volume fraction(CVF) was analyzed by picrosiris-red staining plus polarized microscopy. MMP-2 and -9 gelatinolytic activity were measured by gelatin-zymography. mRNA level of MMP-2, MMP-9, TIMP-1 and TIMP-2 were measured by real-time quantitative PCR. TIMP-1 and TIMP-2 protein level were measured by immunoblotting.

RESULTSMyocardial cross-sectional area of transplanted heart was significantly reduced, and accompanied by excessive ECM deposition (CVF 5.22% +/- 1.6% vs. 2.21% +/- 0.9%, P < 0.05) compared to in situ heart. MMP-2 and MMP-9 activity were significantly increased, as well as mRNA level of MMP-2, MMP-9, TIMP-1 and TIMP-2 compared to in situ heart. TIMP-1 and TIMP-2 protein level in mechanically unloaded heart were significantly upregulated compared to in situ heart, especially for TIMP-1.

CONCLUSIONMechanical unloading of left ventricle may lead to excessive ECM deposition, accompanied by imbalance between MMPs and TIMPs system, especially the upregulation of TIMPs.

Animals ; Extracellular Matrix ; metabolism ; Gelatinases ; metabolism ; Heart Transplantation ; physiology ; Heart-Assist Devices ; Male ; Matrix Metalloproteinases ; metabolism ; RNA, Messenger ; metabolism ; Rats ; Rats, Inbred Lew ; Tissue Inhibitor of Metalloproteinases ; metabolism ; Transplantation, Heterotopic ; physiology ; Ventricular Dysfunction, Left ; metabolism