Objective To investigate the effect of chondroitinase ABC (ChABC) on the expression of growth associated protein 43 (GAP-43) and gl ial fibrillary acidic protein (GFAP) after spinal cord injury (SCI) in rats. Methods A total of 150 adult female SD rats, weighing 250-300 g, were randomly divided into ChABC treatment group (group A), sal ine treatment group (group B), and sham operation group (group C) with 50 rats in each group. In groups A and B, the rats were made the SCI models and were treated by subarachnoid injection of ChABC and sal ine; in group C, the rats were not treated as a control. At 1, 3, 7, 14, and 21 days after operation, the Basso, Beattie, and Bresnahan (BBB) score system was used toevaluate the motion function, and immunofluorescent histochemical staining was used to observe the expressions of GAP-43 and GFAP. Results At different time points, the BBB scores of groups A and B were significantly lower than those of group C (P lt; 0.05); there was no significant difference in BBB score between groups A and B after 1, 3, and 7 days of operation (P gt; 0.05), but the BBB score of group A was significantly higher than that of group B after 14 and 21 days of operation (P lt; 0.01). At different time points, the GAP-43 and GFAP positive neurons of groups A and B were significantly higher than those of group C (P lt; 0.05). After 14 and 21 days of operation, the GAP-43 positive neurons of group A were more than those of group B (P lt; 0.01). After 7, 14, and 21 days of operation, the GFAP positive neurons of group A were significantly less than those of group B (P lt; 0.01). Conclusion ChABC can degrade gl ial scar, improve the microenvironment of the injured region and enhance the expression of GAP-43, which promotes axonal growth and extension.
ObjectiveTo evaluate the effect of poly-amino acid/nano-hydroxyapatite/calcium sulfate (PHC) Cage in lumbar interbody fusion of the goat.
MethodsEighteen mature female goats (weighing 29-33 kg) were divided into 3 groups randomly: PHC Cage group (group A), titanium Cage group (group B), and ilium group (group C). A left extraperitoneal approach was used to establish the animal model of discectomy and interbody fusion with Cage or ilium. The general situation was observed for 24 weeks after operation. X-ray films were taken to measure disc space height (DSH) before operation and at 4, 12, and 24 weeks after operation. CT three dimensional reconstuction was performed at 24 weeks after operation to evaluate the interbody fusion according to modified Brantigan grading. The specimens of L3, 4 were harvested for mechanical test, histological, and scanning electron microscope (SEM) observation at 24 weeks after operation.
ResultsAll goats survived to the end of experiment. DSH at 4 weeks after operation increased when compared with preoperative one in each group, and then decreased;DSH was significantly lower at 12 and 24 weeks after operation than preoperative one in group C (P<0.05). There was no significant difference in DSH among 3 groups at preoperation and 4 weeks after operation (P>0.05);at 12 and 24 weeks after operation, DSH of groups A and B was significantly higher than that of group C (P<0.05), but no significant difference was found between groups A and B (P>0.05). CT three dimensional reconstuction showed that bony fusion was obtained in all goats of groups A and C, and in 3 goats of group B;according to modified Brantigan grading, the scores of groups A and C were significantlly higher than that of group B (P<0.05), but no significant difference between groups A and C (P>0.05). The biomechanical test showed that there was no significant difference in range of motion between group A and group B (P>0.05), which were significantly lower than that of group C (P<0.05). Microscopy and SEM observations showed that the interface between the Cage and vertebral body in group A was compact without obvious gap, and most conjunctive region was filled with osseous tissue;the interface was filled with soft tissue, and the connection was slack with obvious gap in some region in group B;the interface connection was compact, most region was filled with osseous tissue in group C.
ConclusionThe interbody fusion with PHC Cage is effective in goat lumbar interbody fusion model. The interface connection is compact between the Cage and the host bone followed by micro-degradation of PHC Cage, but the long-term degradation need further observation.
ObjectiveTo investigate the short-term effectiveness of balloon vertebroplasty combined with short-segment pedicle screw instrumentation for the treatment of thoracolumbar burst fractures.
MethodsBetween June 2011 and December 2013, 22 patients with thoracolumbar burst fractures were included. There were 14 males and 8 females, aged 20-60 years (mean, 42.5 years). The fracture segments included T11 in 1 case, T12 in 4 cases, L1 in 10 cases, L2 in 6 cases, and L3 in 1 case. According to AO classification system, there were 13 cases of type A and 9 cases of type B. Spinal cord injury was classified as grade C in 2 cases, grade D in 3 cases, and grade E in 17 cases according to Frankel scale. The time from injury to operation was 3-10 days (mean, 5.5 days). All patients underwent posterior reduction and fixation via the injured vertebra, transpedicular balloon reduction of the endplate and calcium sulfate cement (CSC) injection. The ratio of anterior vertebral height, the ratio of central vertebral height, the sagittal Cobb angle, the restoration of nervous function, and internal fixation failure were analyzed.
ResultsPrimary healing of incision was obtained in the others except 2 cases of poor healing, which was cured after dressing change or debridement. All the patients were followed up 9-40 months (mean, 15 months). CSC leakage occurred in 2 cases. Absorption of CSC was observed at 8 weeks after operation with complete absorption time of 12-16 weeks (mean, 13.2 weeks). The mean fracture healing time was 18.5 weeks (range, 16-20 weeks). The ratio of anterior vertebral height, ratio of central vertebral height, and sagittal Cobb angle were significantly improved at 1 week and 3 months after operation and last follow-up when compared with preoperative values (P<0.01), but no significant difference was found among 3 time points after operation (P>0.01). There was no internal fixation failure or Cobb angle loss more than 10°. Frankel scale was improved with no deterioration of neurologic function injury.
ConclusionBalloon vertebroplasty combined with short-segment pedicle screw instrumentation is simple and safe for the treatment of thoracolumbar burst fractures, and it can improve the quality of reduction, restore vertebral mechanical performance effectively, and prevent the loss of correction and internal fixation failure.
ObjectiveTo fabricate an injectable composite bone substitute with hyaluronic acid (HA) and calcium sulfate and to evaluate the biocompatibility and effect of the composite on cell proliferation, osteogenic differentiation in vitro and osteogenic capability in vivo. MethodsCalcium sulfate powder was mixed with HA solution, cross-linked HA solution, and phosphate buffer solution (PBS) in a ratio of 2∶1 (W/V) to get composites of CA+HA, CA+HAC, and CA. The standard extracts from above 3 materials were prepared according to ISO10993-5, and were used to culture mouse MC3T3-E1 cells. The composite biocompatibility and cell proliferation in different concentrations of extract were tested with cell counting kit-8 (CCK-8). The cells were cultured with standard medium as a control. The optimal concentration was selected for osteogenic differentiation test, and ELISA Kit was used to determine the alkaline phosphatase (ALP), collagen type I (COL-I), and osteocalcin (OCN). The femoral condylar bone defect was made on New Zealand white rabbits and repaired with CA+HA, CA+HAC, and CA. Micro-CT was done to evaluate new bone formation with bone volume/tissue volume (BV/TV) ratio at 6 and 12 weeks. HE staining was used to observe bone formation. ResultsCA+HA and CA+HAC were better in injectability and stability in PBS than CA. The biocompatibility test showed that absorbance (A) value of CA group was significantly lower than that of control group (P<0.05) at 6, 12, and 24 hours after culture, but no significant difference was found inA values between CA+HA group or CA+HAC group and control group (P>0.05). The proliferation test showed 25% and 50% extract of all 3 materials had significantly higherA value than control group (P<0.05). For 75% and 100% extract, only CA+HA group had significantly higherA value than control group (P<0.05). And 50% extract was selected for osteogenic differentiation test. At 14 and 21 days, ALP, COL-I and OCN concentrations of CA+HA group and CA+HAC group were significantly higher than those of CA group and control group (P<0.05). Micro-CT results showed higher BV/TV in CA+HA group and CA+HAC group than CA group at 6 and 12 weeks (P<0.05), but no significant difference was found between CA+HA group and CA+HAC group (P>0.05). HE staining revealed that a little bone tissue was seen in CA+HA group and CA+HAC group, but there was no bone formation in CA group at 6 weeks; more streak bone tissue in CA+HA group and CA+HAC group than CA group at 12 weeks. ConclusionComposites prepared with calcium sulfate and HA or with cross-linked HA are stable, injectable, and biocompatible. The materials have excellent effect on proliferation and differentiation of mouse MC3T3-E1 cells. They also show good osteogenic capability in vivo. So it is a potential bone substitutes for bone defective diseases.
ObjectiveTo observe the ability of osteogenesis in vivo using the injected absorbable polyamine acid/calcium sulfate (PAA/CS) composites and assess their ability to repair bone defects.
MethodWe selected 48 New Zealand white rabbits, and half of them were male with a weight between 2.0 and 2.5 kg. Bone defect models were made at the rabbit femoral condyle using electric drill, and the rabbits were divided into two groups. One group accepted implantation of the material at the defect, while nothing was done for the control group. After four, eight, twelve and sixteen weeks, the animals were killed. The line X-ray and hard tissue slices histological examination (HE, MASSON staining) were observed to assess the situation of degradation, absorption and bone formation of the material.
ResultsFour weeks after operation, bone defect of the experimental group had no obvious callus growth on X-ray imaging. Histology showed that the material began to degrade and new immature trabecular bone grew. The bone defect of the experimental group had a small amount of callus growth on X-ray imaging after eight weeks. And histology showed that the material continued to degrade and new immature trabecular bone grew continually. There was an obvious callus growth after twelve weeks, and the bone defect area had smaller residual low-density shadow on X-ray imaging. Histology showed that most of the materials degraded and parts of woven bone grew into lamellar bone. After sixteen weeks, the composites were absorbed completely, replaced by new bone tissues, and the new bone was gradually changed from woven bone into mature plate of bone. There was no significant change in bone defect in the control group within twelve weeks, and part of bone defect hole became smaller, and partial edge repair could be detected.
ConclusionsThe PAA/CS composites can be completely degraded and absorbed, with a certain activity of bone formation, expected to be used as bone repair materials.
Objective To formulate a rational adjuvant therapeutic evidence-based nursing plan for a patient with grade II red and swelling type phlebitis. Methods According to the condition of the patient and using the PICO principle, we put forward clinical problems. Then we comprehensively searched the National Guideline Clearinghouse (NGC), ACP Journal Club, The Cochrane Library, DARE, PubMed, MEDLINE, CNKI and Google Scholar from 2000 to 2012. Relevant clinical guidelines, evidence summaries, systematic reviews/ meta-analyses, randomized controlled trials (RCTs), and high quality reviews on adjuvant therapy of grade II red and swelling type phlebitis were collected and their authenticity, importance and applicability were evaluated. Results One systematic review, four meta-analyses, five RCTs, and one review were totally included. According to current evidence as well as the patient’s clinical conditions and preference, a comprehensive and effective adjuvant therapeutic and nursing programme was given to the patient. For grade II red and swelling type phlebitis with blisters and severe pain, paretic infusion should be immediately stopped on the lesion-side limb, and venous indwelling needle should be extracted. Then, mucopolysaccharide polysulfate cream should be applied on the skin impaired by vein inflammation, and the local area should be gently massaged for 3 min, twice daily (once in the morning and evening, respectively). After four-day treatment and nursing care, the patient with phlebitis had already recovered. Conclusion Evidence-based medicine approaches could help us develop comprehensive therapeutic plans for patients which promote recovery of patients with phlebitis, alleviate pain, improve health, and increasepatients’ quality of life.
Objective To evaluate the tissue response induced by three kinds of bone transplantation materials implanted in rat so as to provide proper evidence for their cl inical appl ication. Methods Thirty-six healthy mature Sprague- Dawly mice, weighing from 229 g to 358 g, were randomly assigned to groups A and B (n=18). Three kinds of materials wereimplanted into muscles of rats. Calcium sulfate (CS) granular preparations and allogeneic demineral ized bone matrix (DBM) were transplanted into the left (group A1) and right (group A2) thigh muscle pouches of group A. Respectively, whereas xenogenic DBM were transplanted into the left (group B1) thigh muscle pouches of group B and the right (group B2) sites were taken as control without implant. The samples (n=6) were collected to make the observation of gross and histology and to analyze histological score after 2, 4, and 6 weeks. Results The gross observation: implanted materials were gradually absorbed at late stage in group A1. No obvious degradation and absorption, but fibrosis of tissues were observed in group A2 and B1. The inflammatory reactions were more severe in groups A2 and B1. In group B2, only the changes of scar were seen at operative site. The histological observation: no obvious inflammatory reactions were seen in group A1, CS were gradually absorbed and completely absorbed at 6 weeks, while fibrosis of tissues increased at late stage. Inflammatory reactions in group A2 and group B1 were alleviated gradually, no obvious absorption and degradation were observed. The different two DBM could induce granulation tissues and bone formation at different sites and secondary fibrosis with no obvious immune response was observed. In group B2, there was an increase in collagen fiber density and angiogenesis at late stage. The scores of inflammatory infiltration were significantly higher in groups A2, B1 than in groups A1, B2 (P lt; 0.05), and the scores of fibrosis was larger in groups A1, A2 and B1 than in group B2 (P lt; 0.05). Conclusion CS has rapid dissolution and good biocompatibil ity. It is a good replaceable packing materials of bone defects in some upper l imb’s or acute bone fracture. Both of two DBM have biocompatibil ity and osteoinductive potential, which dissolution are very slow. Due to these capacity, they can be served as an ideal materials in treatment of lower l imb’s bone defect and nonunion.
【Abstract】ObjectiveTo study Toll like receptor 4 (TLR4) expression on peripheral blood monocytes (PBMCs) during the early stage of human acute pancreatitis. MethodsThirty consecutive patients with acute pancreatitis admitted within 24 h of onset of abdominal pain were enrolled in this study. Another 20 healthy volunteers were included as control. Blood samples were collected by venipuncture on the day of admission and 3， 7 d after admission and PBMCs were isolated. TLR4 and CD14 expressions on PBMCs were detected by flow cytometry. Serum tumor necrosis factor alpha (TNF-α) and interleukin 6 (IL-6) were measured simultaneously. Correlations between these parameters were analyzed. ResultsTLR4 expression increased on the day of admission and then continued to decline for several days. On third day, TLR4 expression was almost normal compared with the normal control. The alteration of serum TNF-α was consistent with that of TLR4. ConclusionDuring the early stage of human acute pancreatitis, mononuclear-macrophages may be ignited through TLR4 (a door keeper of innate immune system), which lead to TNF-α production.
ObjectiveTo systematically review the association between dehydroepiandrosterone-sulfate (DHEA-S) and chronic urticarial (CU).
MethodsWe searched databases including The Cochrane Library (Issue 3, 2015), PubMed, EMbase, CBM, VIP, CNKI and WanFang Data from inception to January 2016, to collect case-control studies about the association between DHEA-S and CU. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was performed by using RevMan 5.3 software.
ResultsA total of 8 papers involving 9 case-control studies were included. The results of meta-analysis showed that DHEA-S might be associated with CU (SMD=-0.93, 95%CI -1.35 to -0.50, P<0.000 01). Subgroup analysis by the difference of measuring methods, indicated that DHEA-S might be associated with CU (ECLIA: SMD=-0.75, 95% CI -1.08 to -0.42, P<0.000 01; ELISA: SMD=-0.59, 95% CI -0.87 to -0.31, P<0.000 1; EIA: SMD=-2. 70, 95% CI -3.30 to -2.10, P<0.000 01). Sensitivity analysis showed that our results were reliable and stable.
ConclusionThe meta-analysis suggests that DHEA-S might be associated with CU. Due to the limited quality and quantity of included studies, more high quality studies are needed to verify the above conclusion.
【Abstract】 Objective To investigate the effectiveness of the medical calcium sulfate—OsteoSet bone graft substitute in the treatment of defect after excision of jaw cyst. Methods Between December 2009 and May 2010, 15 cases of jaw cystic lesion were treated，including 9 males and 6 females with an average age of 36.6 years (range, 15-75 years). Orthopantomography (OPT) method was used to measure the cyst size before operation, and the size ranged from 1.5 cm × 1.5 cm to 8.0 cm × 3.0 cm. The range of bone defect was from 1.5 cm × 1.5 cm × 1.5 cm to 8.0 cm × 3.0 cm × 3.0 cm after cyst excision intraoperatively. The patients underwent cyst curettage and OsteoSet bone graft substitutes implantation (2-15 mL). Radiological method was used to evaluate the repair effect of OsteoSet pellets. Results The pathology biopsy was periapical cyst in 7 cases, odontogenic keratocyst in 5 cases, and dentigerous cyst in 3 cases. Fifteen patients were followed up 6-12 months. Thirteen patients achieved wound healing by first intention; 2 cases had longer drainage time (5 and 7 days, respectively), the incision healed after the pressure bandage. Swelling occurred in 1 case after 1 month with no symptom of infection. No postoperative infection and rejection was found. The X-ray examination showed that the materials filled the bone defect well after 1 day of operation. OsteoSet bone graft substitutes were absorbed by one-half after 1 month of operation and totally after 3 months by OPT. The low density area was smaller in the original cysts cavity, and high density in the cysts increased significantly with fuzzy boundaries of cysts. At 6 months after operation， there was no obvious difference in image density between the original cavity and normal bone, and the capsule cavity boundary disappeared, and defect area was full of new bone. Conclusion The medical calcium sulfate—OsteoSet bone graft substitute is an ideal filling material for bone defect.
