Multi‐lineage differentiation and angiogenesis potentials of pigmented villonodular synovitis derived mesenchymal stem cells ‐ pathological implication

Pigmented villonodular synovitis (PVNS) is a benign tissue proliferation characterized by its hyper‐vascularity within the lesion. The true etiology and cell source of this disease entity still remain unclear. Mesenchymal stem cells (MSCs) exist in various tissues of human body. However, it has not been clarified whether MSCs could be isolated from tissue of PVNS. Here, we isolated MSCs from PVNS (PVNS‐SCs), and by comparing to the MSCs from normal synovium (Syn‐SCs) of the same individual, we investigated whether PVNS‐SCs differed in the capacity for multi‐differentiation and inducing angiogenesis. We first demonstrated that PVNS‐SCs existed in the lesion of PVNS of three individuals. Moreover, we showed PVNS‐SCs had better osteogenic differentiation potential than Syn‐SCs, whereas Syn‐SCs had better capacity for adipogenic and chondrogenic differentiation. By genome–wide analysis of gene expression profile using a complementary DNA microarray and comparing to Syn‐SCs, we identified in PVNS‐SCs a distinct gene expression profile characterized by up‐regulation of genes involved in angiogenesis. In vitro and in vivo studies further confirmed that PVNS‐SCs had better capacities for promoting angiogenesis. In summary, the identification of PVNS‐SCs in PVNS tissue and their distinct angiogenic potential may help elucidate the underlying etiology of this disease. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:395–403, 2016.     

Quantitative comparison of the dynamic flow waveform changes in 12 ruptured and 29 unruptured ICA–ophthalmic artery aneurysms

Introduction

Studies have reported a correlation between blood flow dynamics in the cardiac cycle and vascular diseases, but research to analyze the dynamic changes of flow in cerebral aneurysms is limited. This quantitative study investigates the temporal changes in flow during a cardiac cycle (flow waveform) in different regions of aneurysms and their association with aneurysm rupture.

Methods

Twelve ruptured and 29 unruptured aneurysms from the internal carotid artery–ophthalmic artery segment were studied. Patient-specific aneurysm data were implemented to simulate blood flow. The temporal flow changes at different regions of the aneurysm were recorded to compare the flow waveforms.

Results

In more than 60 % of the cases, peak flow in the aneurysm sac occurred after peak flow in the artery. Flow rate varied among cases and no correlation with rupture, aneurysm flow rate, and aneurysm size was found. Higher pulsatility within aneurysm sacs was found when comparing with the parent artery (P?<?0.001). Pulsatility was high throughout ruptured aneurysms, but increased from neck to dome in unruptured ones (P?=?0.021). Significant changes between inflow and outflow flow profile were found in unruptured aneurysms (P?=?0.023), but not in ruptured aneurysms.

Conclusion

Quantitative analysis which considers temporal blood flow changes appears to provide additional information which is not apparent from aneurysmal flow at a single time point (i.e., peak of systole). By considering the flow waveform throughout the cardiac cycle, statistically significant differences were found between ruptured and unruptured cases — for flow profile, pulsatility and timing of peak flow.     

Perfusion CT compared to H<Subscript>2</Subscript><Superscript>15</Superscript>O/O<Superscript>15</Superscript>O PET in patients with chronic cervical carotid artery occlusion

INTRODUCTION: The purpose of this study was to compare the results of perfusion computed tomography (PCT) with those of (15)O(2)/H(2) (15)O positron emission tomography (PET) in a subset of Carotid Occlusion Surgery Study (COSS) patients. MATERIALS AND METHODS: Six patients enrolled in the COSS underwent a standard-of-care PCT in addition to the (15)O(2)/H(2) (15)O PET study used for selection for extracranial-intracranial bypass surgery. PCT and PET studies were coregistered and then processed separately by different radiologists. Relative measurement of cerebral blood flow (CBF) and oxygen extraction fraction (OEF) were calculated from PET. PCT datasets were processed using different arterial input functions (AIF). Relative PCT and PET CBF values from matching regions of interest were compared using linear regression model to determine the most appropriate arterial input function for PCT. Also, PCT measurements using the most accurate AIF were evaluated for linear regression with respect to relative PET OEF values. RESULTS: The most accurate PCT relative CBF maps with respect to the gold standard PET CBF were obtained when CBF values for each arterial territory are calculated using a dedicated AIF for each territory (R (2) = 0.796, p < 0.001). PCT mean transit time (MTT) is the parameter that showed the best correlation with the count-based PET OEF ratios (R (2) = 0.590, p < 0.001). CONCLUSION: PCT relative CBF compares favorably to PET relative CBF in patients with chronic carotid occlusion when processed using a dedicated AIF for each territory. The PCT MTT parameter correlated best with PET relative OEF.     

Epidemiology of hospitalized burns patients in Taiwan

Previous studies based on either single hospital data or sampling of specific groups of hospitalized burns victims in Taiwan have provided only minimal epidemiological information. The study is designed to provide additional data on the epidemiology of hospitalized burns patients in Taiwan. Data were obtained from the Burn Injury Information System (BIIS), which brings together information supplied by 34 contracted hospitals. The study time course spanned a 2-year period from July 1997 to June 1999. Patient characteristics (age, sex, education level, etc.), causes and severity of injuries, and medical care measures were explored. A total of 4741 patients were registered with BIIS over the study period. The majority of hospitalized patients (67%) were male. The age distribution of burns patients showed peaks occurring at the age groups of 0-5 and 35-44 years. Over the time course of a day, burn injuries occurred more frequently from 10:00 to 12:00 h and 16:00 to 18:00 h. Injuries suspected as the result of suicide, homicide or child abuse accounted for 4.8% of hospitalized cases. More than 48% of the burns occurred in the home. The leading type of burn injury was scalding, followed by naked flame, explosion, electrical burns, and chemical burns due to caustic or corrosive substances. The mean percent total body surface area (%TBSA) for adults was 19%, and for young children was 12%. The average length of hospital stay was 18 days. In conclusion, children under 5 years and adults between 35 and 44 years of age are two high-risk groups for burn injuries. Corresponding to meal preparation time, hot substances such as boiling water, hot soup, etc. are the most common agents responsible for scalds. Prevention programs for reducing the risk of burn injuries during cooking and eating are required, especially for parents with young children.     

Small-dose propofol sedation attenuates the formation of reactive oxygen species in tourniquet-induced ischemia-reperfusion injury under spinal anesthesia

The release of a tourniquet produces reactive oxygen species (ROS), which can cause ischemia-reperfusion injury. We investigated the effects on ROS production in 22 adult ASA physical status I-II patients sedated with small-dose propofol infusion and IV midazolam undergoing elective total knee replacement under intrathecal anesthesia, allocated randomly to one of two groups. In the Propofol group, sedation was performed with propofol 0.2 mg/kg followed by infusion at a rate of 2 mg. kg(-1). h(-1). In the Control group, IV midazolam 5 mg was given. ROS production was measured by lucigenin chemiluminescence analysis. Blood samples were obtained from the radial artery after spinal anesthesia, 1 min before release of the tourniquet and 5 and 20 min after reperfusion. The ischemic time was approximately 70 min. ROS production decreased nonsignificantly before reperfusion in both groups but increased significantly 5 and 20 min after reperfusion in the Midazolam group. In the Propofol group, no significant increase of ROS production was found. We conclude that small-dose propofol infusion attenuates ROS production in tourniquet-induced ischemia-reperfusion injury. IMPLICATIONS: Small-dose propofol sedation, compared with IV midazolam, attenuates free radical production after release of the tourniquet during total knee replacement under spinal anesthesia.     

Anterior lateral thigh flap for buccal mucosal defect after resection of buccal cancer.

OBJECTIVE: To preserve oral function after buccal cancer resection, a free anterior lateral thigh flap (ALTF) was used to cover the buccal mucosal defect. STUDY DESIGN AND SETTING: Nine patients who underwent primary surgical treatment between June 2005 and September 2006 for buccal cancer were enrolled in this study. An ALTF was used to repair the defect immediately after tumor resection. Oral function, including mouth-opening width, oral intake, and teeth cleaning, were compared pre- and postoperatively. RESULTS: No difference was observed in the mouth-opening width between that preoperatively and three months postoperatively (P = 0.54). The oral intake and teeth cleaning also remained unchanged three months postoperatively. CONCLUSION: Repair of a buccal mucosa defect with a free anterior lateral thigh flap is a good alternative for selected patients who undergo resection of buccal cancer; oral function is likely to be preserved.     

A new technique of transferring island pedicled anterolateral thigh and vastus lateralis myocutaneous flaps for reconstruction of recurrent ischial pressure sores.

We describe island pedicled anterolateral thigh and vastus lateralis myocutaneous flaps for reconstruction of the difficult, recurrent ischial pressure sore. Rather than transfer through a subcutaneous tunnel, the flap is transferred directly through the upper thigh to the ischial defect. A total of 15 patients with 16 recurrent ischial pressure sores were treated between May 2003 and April 2005. Eleven sores were treated with pedicled island anterolateral thigh flaps and five sores with vastus lateralis myocutaneous flaps. There was no difficulty in transferring the flap to reach the ischial defect in any patient. The length of the pedicle ranged from 8.5 to 14 cm. All donor sites were closed primarily. Fifteen of the 16 flaps survived completely. Total necrosis occurred in one vastus lateralis myocutaneous flap, which was located at the distal third of the thigh. We conclude this flap can be added to the repertoire for the treatment of recurrent, difficult ischial pressure sores.