A Cell-Free Collagen Type I Device for the Treatment of Focal Cartilage Defects

The purpose of this study was to evaluate the potential value of a cell-free collagen type I gel plug for the treatment of focal cartilage defects. Cellular migration and proliferation was addressed in vitro, and the formation of repair tissue in a nude mouse-based defect model. A cell-free plug made of collagen type I was placed in the center of an incubation plate. Surrounding space was filled with a collagen type I gel (Arthro Kinetics, Esslingen, Germany) seeded with 2 × 10⁵ human articular chondrocytes/mL gel. After cultivation for up to 6 weeks in vitro, samples were subject to histological and immunohistochemical staining and gene expression analysis. Subsequently, chondral defects of human osteochondral blocks were treated with the plug, and specimens were cultivated subcutaneously in nude mice for 6 weeks. The repair tissue was evaluated macroscopically, and collagen type II production was investigated immunohistochemically. In vitro, morphology of immigrated cells did not show any differences, as did collagen type II gene expression. After 4 weeks, the plug was homogeneously inhabited. After 6 weeks of cultivation in nude mice, collagen gel plug treatment led to a macroscopically excellent repair tissue. Histological staining revealed a tight bonding, and the collagen gel plug started to be remodeled. We conclude that the novel collagen gel plug device offers an environment favorable for the migration of articular chondrocytes and leads to a good-quality repair tissue in the nude mouse model. The arthroscopic transplantation of a collagen gel plug may be one option in the treatment of focal cartilage defects.     

Focal Therapy in Prostate Cancer: International Multidisciplinary Consensus on Trial Design

Background

Focal therapy has been introduced for the treatment of localised prostate cancer (PCa). To provide the necessary data for consistent assessment, all focal therapy trials should be performed according to uniform, systematic pre- and post-treatment evaluation with well-defined end points and strict inclusion and exclusion criteria.

Objective

To obtain consensus on trial design for focal therapy in PCa.

Design, setting, and participants

A four-staged consensus project based on a modified Delphi process was conducted in which 48 experts in focal therapy of PCa participated. According to this formal consensus-building method, participants were asked to fill out an iterative sequence of questionnaires to collect data on trial design. Subsequently, a consensus meeting was held in which 13 panellists discussed acquired data, clarified the results, and defined the conclusions.

Outcome measurements and statistical analysis

A multidisciplinary board from oncologic centres worldwide reached consensus on patient selection, pretreatment assessment, evaluation of outcome, and follow-up.

Results and limitations

Inclusion criteria for candidates in focal therapy trials are patients with prostate-specific antigen <15 ng/ml, clinical stage T1c–T2a, Gleason score 3 + 3 or 3 + 4, life expectancy of >10 yr, and any prostate volume. The optimal biopsy strategy includes transrectal ultrasound-guided biopsies to be taken between 6 mo and 12 mo after treatment. The primary objective should be focal ablation of clinically significant disease with negative biopsies at 12 mo after treatment as the primary end point.

Conclusions

This consensus report provides a standard for designing a feasible focal therapy trial.

Patient summary

A variety of ablative technologies have been introduced and applied in a focal manner for the treatment of prostate cancer (PCa). In this consensus report, an international panel of experts in the field of PCa determined pre- and post-treatment work-up for focal therapy research.     

自体镶嵌式骨软骨移植治疗伴局灶性软骨缺损的膝骨性关节炎

目的探讨自体镶嵌式骨软骨移植修复膝骨性关节炎负重区局灶性软骨缺损的可行性和疗效。方法2004年1月～2006年11月,对19例伴局灶性软骨缺损的膝骨性关节炎采用自体镶嵌式骨软骨移植技术治疗,在关节镜下行非负重区自体骨软骨移植修复软骨缺损,术后给予中药口服、玻璃酸钠关节腔注射,6周下地部分负重。定期随访,根据改良Lysholm评分标准、关节液蛋白多糖(PG)、膝关节MRI评价疗效。结果术后获随访12～34(平均24个月)个月,患者疼痛基本消失,功能良好。术前改良Lysholm评分15～63(39.7±4.6)分,术后54～100(93.1±5.9)分,有显著性差异(P<0.01)。术前关节液蛋白多糖215.5～897.3(508.8±203.6)μg/L,术后80.4～571.6(263.5±141.2)μg/L,治疗前后相比,差异有统计学意义(P<0.05)。术后复查MRI示原缺损区软骨表面光滑,移植的软骨下骨愈合良好,总有效率94.8。结论关节镜下自体骨软骨移植创伤小,结合中药口服、玻璃酸钠关节腔注射是治疗伴软骨缺损的膝骨性关节炎的有效方法。     

Adrenaloma: A Call for More Aggressive Management

p = 0.001). Of the 57 resected tumors, 23 were cortical adenomas, 7 myelolipomas, 8 adrenal cysts, 11 nodular hyperplasias, 2 primary adenocarcinomas, 2 metastatic carcinomas, and 4 pheochromocytomas. The mean diameter was 5.89 cm and the mean weight 114.07 g. The mean diameter of the resected primary adenocarcinomas was 3.0 cm and 4.5 cm, respectively. The operative mortality was zero and the perioperative morbidity minimal. The mean operating time was 137 minutes (range 60–240 minutes). The posterior approach had the shortest operating time and the laparoscopic approach the shortest hospital stay and the least postoperative need for narcotics. During the 6.2 years mean follow-up period, five patients with preoperative hypertension remained normotensive, and both patients with the resected primary adenocarcinomas are alive without recurrence. We suggest a more liberal surgical approach to patients with adrenalomas because: (1) even small tumors can be malignant or potentially lethal (e.g., pheochromocytomas); (2) some tumors that appear to be nonfunctioning may in reality be functioning; and (3) other nonfunctioning tumors may, with time (and without prior notice), function. The low risk of adrenalectomy especially via the laparoscopic approach can provide an early definitive diagnosis and treatment, avoiding the cost of repeated CT scans and other studies as suggested by the currently prevailing conservative management of these tumors.