骨质疏松性椎体骨折模型的建立

目的:建立大鼠的骨质疏松性椎体骨折模型,探讨骨折愈合程度与X射线、骨结构和力学性能的相互关系,以期能为临床治疗提供科学的指导和理论依据。方法:实验于2005-07/2006-07在解放军兰州军区总医院骨研所完成。实验动物:选择雌性SPF级8个月龄SD大鼠54只。实验分组:采用随机数字法将大鼠分为2组:骨质疏松组和对照组,每组27只。实验干预:骨质疏松组经双背侧手术切除卵巢,对照组行伪手术。术后3个月,所有动物麻醉下,采用L5椎体手术开窗刮除术区内松质骨方法建立人工椎体骨折模型。实验评估:于术后1,2,4,6,8,12周观察两组大鼠腰椎影像学、骨组织切片组织学与受累椎体力学性能。结果:54只SD大鼠全部进入结果分析。①影像学观察:术后两组X射线片示L5椎体有一骨折缺损透光区。对照组在术后6周时原透光区与周围骨质无明显差别,而骨质疏松组原透光区仍清晰可见,于8周时无明显差别。②组织学观察:两组软骨细胞在骨愈合1周时出现,形成软骨岛,但骨质疏松组软骨细胞每高倍视野数量明显少于对照组,另外,软骨细胞改建成成熟骨细胞,骨小梁形成数量,胶原纤维排列与对照组比较有显著性差异。③力学性能:在骨质愈合6～12周,L5椎体的最大载荷、弹性模量、最大应力明显低于同期对照组,差异有显著性意义(P<0.05)。结论:骨质疏松性椎体骨折SD大鼠模型,符合动物模型标准,可用于研究新骨形成与正常骨质结构关系,观察骨质疏松性椎体骨折愈合机制,并证明骨质疏松性松质骨骨折修复过程中,骨折愈合质量降低。     

前后联合入路病灶清除植骨融合内固定治疗腰骶椎结核

目的探讨前后联合入路行结核病灶清除、椎间植骨、后路椎弓根钉系统内固定治疗腰骶椎结核的疗效。方法 2005年1月-2010年5月,采用经腹膜外入路行结核病灶清除,取自体或同种异体髂骨植骨,后路内固定重建脊柱稳定性治疗腰骶椎结核16例。男12例,女4例;年龄38～65岁,平均48岁。病程6～24个月,平均10个月。患者主要临床症状为持续性下腰痛。病变节段:L4、5 3例,L5、S1 8例,L4～S1 5例。腰骶角18～32°,平均22°。术前红细胞沉降率为15～55 mm/1 h,平均25 mm/1 h。术后抗结核治疗12个月。结果手术时间120～240 min,平均180 min;出血量300～600 mL,平均420 mL。术后切口均Ⅰ期愈合,无相关并发症发生。16例均获随访,随访时间12～24个月,平均16个月。随访期间结核病灶无复发,红细胞沉降率均恢复正常,术前下腰痛或下肢放射痛等症状均消失。X线片检查示,患者均于术后8～12个月植骨融合。末次随访时腰骶角为16～31°,平均21°。结论经腹膜外前方入路暴露腰骶椎结核病灶安全可靠,病灶清除后行椎间植骨,后路椎弓根钉内固定系统可有效重建腰骶段的稳定性。     

微环境中间充质干细胞对多孔磷酸钙人工骨的诱导性

BACKGROUND: The osteoinduction by biomaterials has been proven in various animal experiments.     

3D打印多孔β-磷酸三钙负载聚乳酸-羟基乙酸共聚物抗结核药物缓释微球复合材料：构建及细胞毒性评价

BACKGROUND:So far there is a lack of reliable biomedical evidence about the effects of three-dimensionally (3D) printed porous β-tricalcium phosphate (β-TCP) scaffold loading poly(lactic-co-glycolic acid) (PLGA)/anti-tuberculosis drug control-release microspheres on the growth and proliferation of cells, especially osteoblasts.     

功能型骨组织工程支架修复结核性骨缺损

BACKGROUND: Repairing tuberculosis bone defect has become a research focus with the development of anti-tuberculosis functional bone tissue engineering scaffold. OBJECTIVE: To evaluate the preparation, drug release performance and osteogenic properties of the anti-tuberculosis functional bone tissue engineering scaffold. METHODS: PubMed, Chinese Journal Full-text Database, Wanfang databases were searched by computer for articles addressing functional bone tissue engineering scaffold for repair of tuberculosis bone defect. The keywords were “bone tissue engineering scaffold; tuberculosis; bone defect” in English and Chinese. RESULTS AND CONCLUSION: The anti-tuberculosis functional bone tissue engineering scaffold has good drug delivery, biocompatibility, osteogenic properties and anti-tuberculosis properties. As a good choice to avert bone defect relapse, the scaffold enables a long and stable drug release into bone defects to enhance the therapeutic efficacy of anti-tuberculosis drugs topically. Given the technical deficiencies, we can only combine two drugs with the anti-tuberculosis bone tissue engineering scaffold, although the combined use of three or four anti-tuberculosis drugs is preferred. Additionally, a complete course of anti-tuberculosis treatment often lasts for 6-12 months, which cannot be achieved by the existing anti-tuberculosis bone tissue engineering scaffold. Up to now, the effect of this scaffold has not yet been confirmed in animal models, although how to prepare this scaffold has been reported.     

MRI对椎旁脓肿不明显脊柱结核的诊断价值

目的 探讨椎旁脓肿不典型的脊柱结核的影像学特点及外科治疗方法.方法 对15例椎旁脓肿不典型的脊柱结核患者的病史、临床症状及体征、影像表现特点及治疗方法进行分析总结.结果 本组椎体结核病例在X线或CT上不出现典型的椎旁脓肿影像学表现,在椎体骨质弥漫性破坏且椎间隙相对完整时,给椎体结核的诊断带来一定的困难.15例中术前依病史、临床症状及专科体查,仅3例参考X线平片得出椎体结核的诊断.4例X线平片结合CT扫描得出椎体结核的正确判断,余8例辅加MRI检查得以术前确诊.结论 椎旁脓肿不典型性脊柱结核依据X线平片和CT扫描诊断困难时,MRI检查可对该病进行早期准确的诊断,MRI可清晰显示病变椎体、椎旁软组织病理及形态学改变及椎间盘变性情况.     

Highlighting the interaction between immunomodulatory properties of mesenchymal stem cells and signaling pathways contribute to Graft Versus Host Disease management

BackgroundAllogeneic hematopoietic stem cell transplantation (Allo-HSCT) has been increasingly used as a therapeutic approach for hematological malignancies. Several potential strategies have been developed for treating or preventing allo-HSCT complications, specifically graft-versus-host disease (GVHD). GVHD could significantly affect the morbidity and mortality of patients after allo-HSCT. Curative treatment and prophylaxis regimens for GVHD could reduce GVHD incidence and improve survival rate. Among these therapeutic strategies, mesenchymal stem cell (MSCs) mediated immunomodulation has been explored widely in clinical trials. MSCs immunomodulation ability in GVHD correlates with the interactions of MSCs with innate and adaptive immune cells. However, signaling pathways responsible for MSCs' impact on GVHD regulation, like JAK/STAT, NOTCH, MAPK/ERK, and NFκβ signaling pathways, have not been clearly described yet. This review aims to illuminate the effect of MSCs-mediated immunomodulation in GVHD management after allo-HSCT representing the role of MSCs therapy on signaling pathways in GVHD.ConclusionMSCs could potentially modulate immune responses, prevent GVHD, and improve survival after allo-HSCT. Previous studies have investigated different signaling pathways' contributions to MSCs immunoregulatory ability. Accordingly, targeting signaling pathways components involved in MSCs related GVHD regulation is proven to be beneficial.     

Patellar inward pushing method relieves knee osteoarthritis via regulating cytokines

BackgroundKnee osteoarthritis (KOA) is a chronic degenerative disease characterized by pain, morning stiffness and swelling in the knee joints. And KOA is common in the elderly and seriously affects the exercise function and physical health of patients. This study aimed to explore the curative effects of patellar inward pushing method (PIPM) on KOA.Material and methodIn this study, we established rabbit animal models of KOA for the research by using the New Zealand white rabbits. 30 New Zealand white rabbits were divided into 5 groups by random number table method: blank group, model group, glucosamine hydrochloride (GH) group, PIPM group and PIPM combined with GH group, then the rabbits were modeled.ResultsAfter 9-weeks cultured in groups, 5 ml blood was collected from the heart, and cytokines were detected. The result suggested that iNOS, NO and TNF-α were the pathogenic inflammatory factor of KOA, and aggravated cartilage damage and degeneration. Besides, this study indicated that PIPM combined with GH treatment significantly reduced the activity of inflammatory cytokines in serum and joint fluid of KOA models in rabbits. In addition, PIPM combined with GH therapy exhibited the best therapeutic effect among these treatments, which was working on KOA better than PIPM treatment alone or GH treatment alone.ConclusionsPIPM could effective treat KOA via regulating cytokines, and the PIPM combined with GH therapy could be a novel therapeutic strategy of KOA.     

Evanescing renal allograft cortical necrosis from living donor renal transplantation: A lesson learned over two decades

BackgroundRenal graft cortical necrosis (GCN) is a catastrophic cause of graft failure. We evaluated the incidence, causes, management, and outcome of GCN across two decades from our center.MethodsThis is a retrospective analysis of transplant patients who had biopsy-proven GCN transplanted between 2000 and 2020. The clinical details, immunological workup, induction, maintenance regimen, causes of cortical necrosis, and the outcomes were compared between the first period 2000–2012, and the second period 2013–2020, when Flow cytometric and Luminex based crossmatch were included in the workup plan.ResultsAmong 2333 live ABO-compatible renal transplants, 37 (0.015%) patients (36 patients between 2000 and 2012 and 1 between 2013 and 2020) developed GCN (60% had diffuse and 40% patchy GCN) at a median of 8 days after transplantation.Twenty-six (60%) received ATG, 4 received plasmapheresis and ATG (10.8%) as antirejection therapy. The cyclosporine-based regimen was associated with a higher risk of GCN (RR 2.54; 95% CI 1.26 to 5.12, p = 0.009), whereas tacrolimus-based therapy had a lower risk (RR 0.39; 95% CI 0.19 to 0.79, p = 0.009). The introduction of flow cytometry and DSA assay has significantly decreased the incidence of acute rejection and GCN. Only one patient had GCN during the 2013–2020 period because of graft's mucormycosis. Twenty-five (67.56%) patients had no recovery, and 12 (32.43%) had partial recovery of graft function.ConclusionGCN is mainly associated with rejection, and cyclosporin-based maintenance regimen had a higher incidence. The remarkable decrease in GCN after 2012 onwards could be attributed to the use of Flowcytometry, Luminex-based DSA assays, and tacrolimus-based regimens.