Metástasis sacra simulando quiste óseo aneurismático

Cystic spinal lesions with characteristic patterns, such as the presence of haematic fluid-fluid levels (H-FFL), have been associated with many tumoral lineages, more frequently with aneurysmal bone cyst (ABC) and exceptionally with metastasis. We present the case of a 60-year-old man with the finding of a sacral cystic bone lesion with H-FFL, with initial suspicion of ABC and confirmed diagnosis of metastasis. The case presented is, to our knowledge, the second case published of spinal cystic bone metastasis with H-FFL pattern with unknown primary tumour at the time of diagnosis and the only one that received resective surgical treatment, achieving pulmonary and metastatic disease control with good quality of life after 1 year of follow up.     

Evaluation of the presence of VEGF,BMP2 and CBFA1 proteins in autogenous bone graft: Histometric and immunohistochemical analysis

AimsThe purpose of this study was to evaluate the expression of proteins that participate in the osteoinduction stage (VEGF, BMP2 and CBFA1) of the process of bone regeneration of defects created in rat calvariae and filled with autogenous bone block grafts.Materials and methods10 adult male rats (Rattus norvegicus albinus, Wistar) were used, who received two bone defects measuring 5 mm each in the calvariae. The bone defects constituted two experimental groups (n = 10): Control Group (CONT) (defects filled with a coagulum); Graft Group (GR) (defects filled with autogenous bone removed from the contralateral defect). The animals were submitted to euthanasia at 7 and 30 days post-operatively.ResultsQuantitative analysis demonstrated significantly greater bone formation in Group GR, but the presence of the studied proteins was significantly greater in the CONT Group in both time intervals of observation.ConclusionIt was not possible in this study in cortical bone block groups to detect the osteoinductive proteins in a significant amount during the repair process.     

开放楔形胫骨高位截骨术治疗膝关节内侧间室骨关节炎疗效观察

目的探讨开放楔形胫骨高位截骨术（open wedge high tibial osteotomy，OWHTO）治疗膝关节内侧间室骨关节炎的效果。方法回顾分析 2015 年 1 月—2017 年 1 月采用 OWHTO 治疗的 61 例膝关节内侧间室骨关节炎患者临床资料。男 14 例，女 47 例；年龄 44～60 岁，平均 52.8 岁。体质量指数为 19.1～34.7 kg/m²，平均 25.3 kg/m²。左膝 27 例、右膝 34 例。病程 1～9 年，平均 5.3 年。骨关节炎分期：Ⅱ期 33 例，Ⅲ期 28 例。术前膝关节美国特种外科医院（HSS）评分为（56.0±3.7）分，行走时膝关节疼痛视觉模拟评分（VAS）为（4.6±1.0）分。 结果手术时间为 49～85 min，平均 66.5 min；切口长度为 10～13 cm，平均 11.0 cm；总显性失血量为 80～210 mL，平均 139.1 mL；术后卧床时间为 1～10 d，平均 4.7 d。患者均获随访，随访时间 12～24 个月，平均 17.3 个月。术后 3 个月 X 线片测量示胫骨平台负重区为 60.3%～66.8%，平均 63.4%。术后 3、6 个月，膝关节 HSS 评分分别为（79.1±4.2）、（85.3±3.1）分，VAS 评分分别为（1.7±0.7）、（0.6±0.5）分，差异均有统计学意义（P<0.05）。 结论OWHTO 治疗膝关节内侧间室骨关节炎疗效确切，力线纠正理想，并发症较少，但应注意术前需要精确测量术中张开角。     

外固定支架结合有限内固定治疗严重粉碎性Pilon骨折26例疗效分析

目的观察严重粉碎性Pilon骨折患者采用有限内固定结合外固定支架治疗的临床效果。方法选取我科收治的Ruedi-Allgower分型均为Ⅲ型的52例严重粉碎性Pilon骨折患者,并按入院顺序随机分为两组,26例患者采用外固定支架结合有限内固定治疗作为观察组,26例患者采用单纯内固定治疗作为对照组,随访患者2年,采用Mazur等制定的踝关节症状与功能评分系统对本组患者进行疗效评价,并观察两组患者随访期间并发症发生率。结果随访期间观察组无一例发生骨髓炎、钢板及螺钉松动或断裂等并发症,17例优、5例良、4例可,优良率为84.62%。对照组4例(15.38%)发生并发症,10例优、5例良、7例可、4例差,优良率为57.69%,观察组并发症发生率明显低于对照组,优良率明显高于对照组,差异均有统计学意义(P<0.05)。结论采用外固定支架结合有限内固定治疗严重粉碎性Pilon骨折操作安全,对组织损伤小,术后并发症少,利于骨折愈合及关节功能恢复,是治疗严重粉碎性Pilon骨折一种有效的方法。     

Inhibiting effect of Radix Hedysari Polysaccharide (HPS) on endotoxin-induced uveitis in rats

PurposeThe aim of this study is to investigate the anti-inflammatory effect of Radix Hedysari Polysaccharide (HPS) on clinical indicators, the expression of Toll-like receptor-4 (TLR4) and its downstream transduction molecules during endotoxin-induced uveitis in rats.MethodsEIU was induced through the intraperitoneal injection of male Wistar rats with lipopolysaccharide (LPS 200 μg). HPS (400 mg/kg), DXM (1 mg/kg) or an equivalent volume of normal saline was injected intraperitoneally 1 h before the LPS induction. The clinical manifestation was observed and scored at 2-h intervals using a slit microscope. The degree of inflammatory reaction was determined by routine histological examinations, and the expression of TLR4 and MyD88 in the iris-ciliary body complex was detected through a double-labeled immunofluorescence study. Real-time RT-PCR was used to assess the effects of HPS on the expression of the TLR4 complex, MyD88 and NF-κB p65 mRNA. The protein expression levels of TLR4, MyD88 and NF-κB p65 were examined by western blot.ResultsHPS treatment produced similar therapeutic results with dexamethasone by significantly reducing the clinical severity of EIU as well as fibrin exudations and inflammatory cell infiltration in the eye. Correspondingly, according to the immunofluorescence results, HPS treatment significantly suppressed the expression of TLR4 and MyD88 in the iris–ciliary body complex. HPS treatment could also remarkably reduce the mRNA and protein expression of the TLR4 complex, MyD88 and NF-κB p65.ConclusionHPS can suppress the intraocular inflammation observed in EIU by inhibiting TLR4 and its downstream signal transduction pathway.     

Targeted multimodal imaging modalities

Molecular imaging non-invasively visualizes and characterizes the biologic functions and mechanisms in living organisms at a molecular level. In recent years, advances in imaging instruments, imaging probes, assay methods, and quantification techniques have enabled more refined and reliable images for more accurate diagnoses. Multimodal imaging combines two or more imaging modalities into one system to produce details in clinical diagnostic imaging that are more precise than conventional imaging. Multimodal imaging offers complementary advantages: high spatial resolution, soft tissue contrast, and biological information on the molecular level with high sensitivity. However, combining all modalities into a single imaging probe involves problems yet to be solved due to the requirement of high dose contrast agents for a component of imaging modality with low sensitivity. The introduction of targeting moieties into the probes enhances the specific binding of targeted multimodal imaging modalities and selective accumulation of the imaging agents at a disease site to provide more accurate diagnoses. An extensive list of prior reports on the targeted multimodal imaging probes categorized by each modality is presented and discussed. In addition to accurate diagnosis, targeted multimodal imaging agents carrying therapeutic medications make it possible to visualize the theranostic effect and the progress of disease. This will facilitate the development of an imaging-guided therapy, which will widen the application of the targeted multimodal imaging field to experiments in vivo.     

Focusing on functional knee parameter determination to develop a better clinical gait analysis protocol

BackgroundAttempts to improve protocol standards of marker-based clinical gait analysis (CGA) have been one of the main focuses of research to enhance robustness and reliability outcomes since the 1990s. Determining joint centres and axes constitutes an important aspect of those protocols. Although the hip joint is more prominent in such studies, knee joint center (KJC) and axis (KJA) directly affect all outcomes.Research questionWhat recommendations arise from the study of the scientific literature for determining knee joint parameters (KJP) for protocols of CGA?MethodsA systematic, electronic search was conducted on November 2018 using three databases with the keyword combination (“functional approach” OR “functional method” OR “functional calibration”) AND (“hip joint” OR “knee joint” OR “ankle joint”) and analyzed by four reviewers. Given the existence of a recent review about the hip joint and the lack of material about the ankle joint, only papers about the knee joint were kept. The references cited in the selected papers were also screened in the final round of the search for these publications.The quality of the selected papers was assessed and aspects regarding accuracy, repeatability, and feasibility were thoroughly considered to allow for a comparison between studies. Technical aspects, such as marker set choice, KJP determination techniques, demographics, and functional movements, were also included.ResultsThirty-one papers were included and on average received a rating of about 75 % according to the quality scale used. The results showed that functional methods are superior or equivalent to predictive methods to estimate the KJA, while a regression method was slightly better for KJC prediction.SignificanceCalibration methods should be applied to CGA whenever feasibility is reached. No study to date has focused on evaluating the in vivo RoM required to obtain reliable and repeatable results and future work should aim in this direction.     

肿瘤相关巨噬细胞相关性miR-99a对子宫内膜癌细胞生长和侵袭的调控作用

背景与目的：肿瘤相关巨噬细胞（tumor-associated macrophage，TAM）浸润与肿瘤进展密切相关，但作用机制尚不明确，因此，探索miR-99a对单核巨噬细胞极化的影响及其对子宫内膜癌（endometrial cancer，EC）细胞生长、侵袭的影响。方法：检测EC组织中巨噬唾液酸蛋白（macrosialin）CD68表达并分析其与临床病理学特征之间的关系；运用人EC细胞系HEC-1B、RL95-2培养上清液诱导人单核细胞U937向TAM（M2型巨噬细胞）分化；将人工合成的miR-99a模拟物片段转染至诱导后的巨噬细胞，转染后运用实时荧光定量聚合酶链反应（real-time fluorescence quantitative polymerase chain reaction，RTFQ-PCR）及流式细胞术检测巨噬细胞相关因子CD68、CD163以及巨噬细胞甘露糖受体（mcrophage mannose receptor）CD206表达量变化，并运用酶联免疫吸附法（enzyme-linked immunosorbent assay，ELISA）检测巨噬细胞分泌相关细胞因子IL-12、IL-4和IL-10分泌量变化；将转染miR-99a的诱导后巨噬细胞与EC细胞共培养，运用细胞计数试剂盒（cell counting kit-8，CCK-8）和transwell法检测其对EC细胞增殖和侵袭能力的影响，并初步分析其可能的作用机制。结果：EC组织CD68高表达并与肿瘤肌层浸润及血管生成呈正相关；肿瘤细胞培养上清液成功诱导单核细胞向M2型TAM极化。转染miR-99a后单核细胞组CD68及CD163表达较对照组下降（P＜0.01），而CD206表达差异无统计学意义（P＞0.05），流式细胞术进一步证实上述表达变化；ELISA结果发现，转染miR-99a诱导后巨噬细胞中IL-12分泌增多（P＜0.01），而IL-4、IL-10分泌减少（P＜0.01），提示巨噬细胞向M2型极化受抑制。将诱导后巨噬细胞与EC细胞共培养，共培养后EC细胞增殖侵袭能力较对照组增加，而转染miR-99a模拟片段至诱导后巨噬细胞能够抑制其对增殖（P＜0.01）及侵袭能力的促进作用（P＜0.05）。诱导后巨噬细胞中过表达miR-99a后细胞中mTOR及其通路受到抑制。结论：EC间质巨噬细胞浸润与肿瘤肌层浸润及血管新生相关，miR-99a能够逆转单核细胞向M2表型极化，并抑制EC细胞介导TAM的促EC细胞生长和侵袭作用，其作用可能通过调控mTOR通路产生。     

Lifestyle and lifetime occupational exposures may not play a role in the pathogenesis of Modic changes on the lumbar spine MR images

BACKGROUND CONTEXTModic changes (MCs) have long been suspected as a pathologic cause of back pain. Although much attention has been focused on clinical perspectives, the etiology of MCs remains unclear. Although some studies have reported that sex, body mass index (BMI), cigarette smoking, and physical loading may associate with MCs, the observed associations are inconsistent among studies.PURPOSETo investigate associations between MCs and lifestyle and lifetime occupational exposures using a general population sample.STUDY DESIGNCross-sectional study.PATIENT SAMPLEThe study was an extension of the Hangzhou Lumbar Spine Study, a population-based study of mainland Chinese focusing on lumbar degenerative changes. A total of 644 randomly selected subjects from a typical community in Hangzhou, Eastern China participated.OUTCOME MEASURESThe presence and type of MCs in the lumbosacral spine were evaluated on sagittal magnetic resonance images. Demographics, lifestyle factors, and occupational exposures were measured using a structured interview.METHODSUnivariate and multivariate logistic regressions were used to examine the associations of MCs with various environmental exposures.RESULTSAmong the 644 subjects (52.6±13.9 years; range 20–88 years) included in this study, 44.7% had MCs. In univariate regression analyses, the presence of MCs was associated with greater age, higher BMI, greater cigarette smoking, regular exercise, and absence of daily vehicle vibration. Modic changes were not univariately associated with sex or alcohol consumption. In addition, all occupational loading measurements were associated with the occurrence of MCs in univariate analyses, except work time spent in vehicles and work-related back injuries. However, in multivariate regression analyses, no statistically significant associations between the occurrence of MCs and lifestyle or lifetime occupational exposures were observed after adjusting for age, sex, and BMI.CONCLUSIONSAge is an important determinant of MCs, with BMI and sex also playing a role. Lifestyle and occupational factors appear to have minor effects, if any, on the pathogenesis of MCs in the lumbar spine.