Present day controversies and consensus in curettage for giant cell tumor of bone

BackgroundThe ideal treatment for giant cell tumor of bone (GCTB) is still controversial. The purpose of this study was to evaluate whether curettage was successful in the treatment of GCTB. Intralesional curettage with adjuvant therapies, such as high-speed burring, polymethylmethacrylate, phenol, ethanol, and liquid nitrogen, may be used to reduce the local recurrence rate. However, there is no consensus on the optimal use of curettage, along with fillers and adjuvants, to limit the recurrence rate.MethodsWe performed a systematic review of articles using the terms long bones, GCTB, and treatment. Case reports, reviews, opinion articles, or technique notes were excluded based on the abstract. Twenty-six articles included in this review were then studied to establish the index in suggesting the surgical treatment of GCTB.ResultsThe patient’s gender, their age, the Campanacci grade of their tumor, and the type of surgery they had were not significantly associated with the local recurrence rate. Local recurrences seemed to be associated with the site of the tumor, occurring more frequently in the proximal femur or distal radius. A pathological fracture was not a contraindication for intralesional curettage. Treatment with denosumab did not decrease the local recurrence rate in patients who had been treated with curettage.ConclusionThe current literature seems to suggest that the ideal treatment for GCTB is to remove the tumor while preserving as much of the joint as possible. Local recurrent tumors can be treated with curettage to keep the re-recurrence rate within an acceptable limit. The choice for how to treat GCTB in the proximal femur or distal radius requires special attention.     

骨代谢生化指标临床应用专家共识（2019）

骨代谢生化指标包括钙磷代谢调节指标、骨形成标志物、骨吸收标志物、激素与细胞因子。骨代谢生化指标分别来源于骨、软骨、软组织、皮肤、肝、肾、小肠、血液及内分泌腺体等,是由成骨细胞或破骨细胞分泌的酶和激素,以及骨基质的胶原蛋白代谢产物或非胶原蛋白。骨代谢生化指标可及时反映骨转换状态,灵敏度高、特异性强,用于骨质疏松诊断分型、预测骨折风险、抗骨质疏松治疗疗效评价,以及代谢性骨病的鉴别诊断。并且在骨质疏松流行病学、发病机制、骨质疏松药物的研究方面具有重要的临床意义。     

半剂量维替泊芬光动力疗法治疗复发性中心性浆液性脉络膜视网膜病变的临床观察

目的探讨半剂量维替泊芬光动力疗法治疗复发性中心性浆液性脉络膜视网膜病变的临床效果。 方法选取2016年6月至2017年5月于内蒙古自治区赤峰市第二医院眼科确诊为复发性中心性浆液性脉络膜视网膜病变的患者8例(10只眼)。全部患者均采用维替泊芬光动力进行治疗,按照1999年北美和欧洲发表的多中心光动力疗法治疗老年性黄斑变性的药剂使用标准确定患者药剂用量。给予患者常规光动力治疗标准剂量的一半,即根据患者体表面积,静脉注射维替泊芬3 mg/m²,注药结束15 min后,采用光照能量为50 J/cm²、功率密度为600 mW/cm²及体激光波长为689 nm的激光裂隙灯照射83 s。采用单因素重复测量方差分析的方法比较患者治疗前后各时间点的最佳矫正视力(BCVA)及黄斑部视网膜厚度(CMT)的变化。 结果治疗前,患者的BCVA为0.2～0.5,平均为0.34±0.12,治疗3个月后,经复查,患者的BCVA为0.4～1.2,平均为0.78±0.24,患者视力显著提高,差异有统计学意义(t＝－5.18,P<0.05)。治疗3个月后,全部患者均接受光学相干断层扫描检查。检查结果显示,8例(10只眼)患者中,9只患眼完全治愈,即中心凹处视网膜下液完全吸收,占全部患者的90%。1只患眼未完全治愈,占全部患者的10%,患者再次接受治疗后痊愈。治疗后6个月时再次进行复查,经光学相干断层扫描检查,8例(10只眼)患者完全治愈。患者治疗前的CMT为(349±91)μm,治疗后1个月时为(192±60)μm,治疗后3个月时为(184±64)μm,治疗后6个月时为(177±56)μm。经单因素重复测量方差分析,患者各时间点的CMT差异有统计学意义(F＝78.22,P<0.05)。与治疗前相比,治疗后1个月、3个月及6个月的结果均显著优于治疗前,差异有统计学意义(t＝4.32,4.45,4.83;P<0.05)。且治疗后患者的CMT呈现出持续下降的趋势。全部患者于术后1个月、3个月及6个月接受随访。至最后一次随访,中心凹处视网膜下液及CMT均未发现复发情况,也未出现任何并发症。 结论采用光学相干断层扫描技术,使用半剂量维替泊芬光动力治疗复发性中心性浆液性脉络视网膜病变,可以有效改善患者的脉络膜微循环,缩短患者的病程时间,治疗效果显著。     

早期激素性股骨头坏死过程中细胞色素c的作用

BACKGROUND: Studies have shown that apoptosis is closely related to the pathogenesis of steroid-induced femoral head necrosis. The release of cytochrome c plays a very important role in the process of apoptosis. OBJECTIVE: To observe the effects of cytochrome c on early steroid-induced femoral head necrosis. METHODS: Twenty-four healthy adult male New Zealand rabbits at 5 months old were randomly divided into model group and control group (n=12 per group). Models of early steroid-induced femoral head necrosis were established by intragluteal injection of hormone combined with ear vein injection of horse serum. In the control group, rabbits were given ear vein injection of the same amount of physiological saline. At 2, 4 and 6 weeks after model establishment, histopathological changes of bilateral femoral head were observed by optical microscope, and the ratio of empty lacuna was calculated. Apoptosis of osteocytes was determined by TUNEL assay, and apoptotic index was calculated. Immunohistochemical method was used to determine cytochrome c and to calculate cytochrome c-positive expression rate. RESULTS AND CONCLUSION: (1) The ratio of empty lacuna and apoptotic index: The model of early steroid-induced femoral head necrosis was successfully established in the experiment. Compared with the control group, ratio of empty lacuna, apoptotic index and expression rate of cytochrome c in osteocytes were significantly higher in the model group (P < 0.05 or P < 0.01). (2) Correlation analysis: Ratio of empty lacuna was significantly positively associated with apoptotic index at various time points in the model group (r=0.856, P < 0.01). Expression rate of cytochrome c was significantly positively associated with apoptotic index at various time points in the model group (r=0.824, P < 0.01). (3) These findings confirm that cytochrome c-involved apoptosis of osteocytes may play an important role in steroid-induced femoral head necrosis. Expression rate of cytochrome c in osteocytes is remarkably positively associated with the occurrence of steroid-induced femoral head necrosis in rabbits. 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程     

纤毛相关疾病：细胞学机制及转化应用进展

BACKGROUND: Cilium is an antenna-like organelle that plays a vital role in all organs generation and maintenance. Ciliopathies refer to multisystem diseases caused by disorders of the cilia structure and function. OBJECTIVE: To introduce current understanding of the structure and function of the cilium, with a focus on the study progress of ciliopathies. METHODS: PubMed database was searched by computer using the keywords of “primary cilium, motion cilium, ciliopathy”. Totally 371 relevant articles published from 1959 to 2015 were retrieved. After excluding repetitive and irrelevant articles, we enrolled 32 English literatures regarding cilia structure, function and ciliopathies in accordance with the inclusion criteria. RESULTS AND CONCLUSION: Ciliopathies almost involve every system of the human body, such as the brain, eyes, liver, kidney, bone and reproductive system. Most ciliopathies are related to human developmental or degenerative diseases, which characterized by wide-ranging clinical and genetic heterogeneity, such as primary ciliary dyskinesia, ploycystic kidney disease, infertility, blindness and tumor. In view of the medical importance of the cilium, scholars have devoted to studying the underlying cellular mechanisms. These in turn have revealed that ciliopathies are not only caused by defective assembly of the cilium, but also by impaired ciliary signaling. 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程     

成骨细胞、破骨细胞与酒精性股骨头坏死的关联性： 预防与靶向治疗的新思路

BACKGROUND: Alcohol-induced femoral head necrosis is a bone metabolism disease that involves a series of alcoholism-induced pathological changes, including degeneration, necrosis and deposition of adipocytes and osteoporosis, and trabecular collapse in the subchondral bone trabeculae of the femoral head. OBJECTIVE: To introduce the correlation of osteoblasts and osteoclasts with alcohol-induced femoral head necrosis. METHODS: The first author searched relative articles in PubMed and CNKI databases published before May 2016 using the keywords of “osteoblast, osteoclast, alcohol-induced ONFH, bone metabolism” in English and Chinese, respectively. 133 literatures were retrieved and 38 literatures were in accordance with the inclusion criteria. RESULTS AND CONCLUSION: During the process of bone metabolism, osteoblasts and osteoclasts exhibit interaction in term of cell number and viability. In-depth study on osteoblasts, osteoclasts and their interaction cannot only give insight into the pathogenesis and repair of alcohol-induced femoral head necrosis, but also provide new ideas and strategies for prevention and target treatment of bone metabolic diseases. 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程     

Evaluation of a subject-specific musculoskeletal modelling framework for load prediction in total knee arthroplasty

Musculoskeletal (MSK) multibody dynamics (MBD) models have been used to predict in vivo biomechanics in total knee arthroplasty (TKA). However, a full lower limb MSK MBD modelling approach for TKA that combines subject-specific skeletal and prosthetic knee geometry has not yet been applied and evaluated over a range of patients. This study evaluated a subject-specific MSK MBD modelling framework for TKA using force-dependent kinematics (FDK) and applied it to predict knee contact forces during gait trials for three patients implanted with instrumented prosthetic knees. The prediction accuracy was quantified in terms of the mean absolute deviation (MAD), root mean square error (RMSE), Pearson correlation coefficient (ρ), and Sprague and Geers metrics of magnitude (M), phase (P) and combined error (C). Generally good agreements were found between the predictions and the experimental measurements from all patients for the medial contact forces (150 N < MAD <178 N, 174 N < RMSE < 224 N, 0.87 < ρ < 0.95, −0.04 < M < 0.20, 0.06 < P < 0.09, 0.08 < C < 0.22) and the lateral contact force (113 N < MAD <195 N, 131 N < RMSE < 240 N, 0.41 < ρ < 0.82, −0.25 < M < 0.34, 0.08 < P < 0.22, 0.13 < C < 0.36). The results suggest that the subject-specific MSK MBD modelling framework for TKA using FDK has potential as a powerful tool for investigating the functional outcomes of knee implants.     

贝尼地平对小鼠骨髓间充质干细胞成骨分化体外研究

目的在体外环境下探讨贝尼地平对小鼠骨髓间充质干细胞向成骨细胞分化的影响。方法 C57/BL6小鼠骨髓间充质干细胞(bone marrow stromal cells,BMSCs)在成骨诱导培养基条件下经过1μmol/L、10μmol/L和100μmol/L浓度的贝尼地平(BD)处理,1天和14天后采用CCK8法检测细胞增殖情况,以及14天后采用碱性磷酸酶(ALP)染色检测ALP表达量,蛋白免疫印迹(Western Bloting)法检测成骨特征蛋白骨钙素(OCN)和核心结合蛋白因子2(Runx2)以及WNT/β-catenin信号通路关键蛋白β-链蛋白(β-catenin)和低密度脂蛋白相关蛋白5(LRP5)蛋白的表达。结果在本次研究中,贝尼地平浓度在1~100μmol/L对细胞没有毒性作用(P0.05);所有浓度的贝尼地平处理组(1~100μmol/L)中ALP表达量均增加(P0.05),并出现浓度依赖性,随着贝尼地平浓度的增加促进BMSCs表达ALP能力相应增强(P0.05);贝尼地平促进所有处理组(1~100μmol/L)中Runx2的表达(P0.05),并出现浓度依赖性,在贝尼地平浓度为100μmol/L时促进作用最强(P0.05);OCN的表达随着贝尼地平浓度的增加而相应增加(P0.05),在贝尼地平浓度为100μmol/L时达到最大(P0.05);贝尼地平促进β-catenin表达(P0.05),出现随贝尼地平浓度增加而表达增强,促进作用在贝尼地平浓度为100μmol/L时达到最大(P0.05);而LRP5的表达在贝尼地平的作用下得到加强(P0.05)并出现浓度依赖性,在贝尼地平浓度为100μmol/L时达到最大(P0.05)。结论贝尼地平在体外能通过上调WNT/β-catenin信号通路活性促进骨髓间充质干细胞向成骨细胞分化,这对高血压合并骨质疏松患者而言是一个良好的治疗药物。     

Ground reaction force and joint moment estimation during gait using an Azure Kinect-driven musculoskeletal modeling approach

BackgroundGait analysis is burdened by time and equipment costs, interpretation, and accessibility of three-dimensional motion analysis systems. Evidence suggests growing adoption of gait testing in the shift toward evidence-based medicine. Further developments addressing these barriers will aid its efficacy in clinical practice. Previous research aiming to develop gait analysis systems for kinetics estimation using the Kinect V2 have provided promising results yet modified approaches using the latest hardware may further aid kinetics estimation accuracyResearch questionCan a single Azure Kinect sensor combined with a musculoskeletal modeling approach provide kinetics estimations during gait similar to those obtained from marker-based systems with embedded force platforms?MethodsTen subjects were recruited to perform three walking trials at their normal speed. Trials were recorded using an eight-camera optoelectronic system with two embedded force plates and a single Azure Kinect sensor. Marker and depth data were both used to drive a musculoskeletal model using the AnyBody Modeling System. Predicted kinetics from the Azure Kinect-driven model, including ground reaction force (GRF) and joint moments, were compared to measured values using root meansquared error (RMSE), normalized RMSE, Pearson correlation, concordance correlation, and statistical parametric mappingResultsHigh to very high correlations were observed for anteroposterior GRF (ρ = 0.889), vertical GRF (ρ = 0.940), and sagittal hip (ρ = 0.805) and ankle (ρ = 0.876) moments. RMSEs were 1.2 ± 2.2 (%BW), 3.2 ± 5.7 (%BW), 0.7 ± 0.1.3 (%BWH), and 0.6 ± 1.0 (%BWH)SignificanceThe proposed approach using the Azure Kinect provided higher accuracy compared to previous studies using the Kinect V2 potentially due to improved foot tracking by the Azure Kinect. Future studies should seek to optimize ground contact parameters and focus on regions of error between predicted and measured kinetics highlighted currently for further improvements in kinetic estimations.