Treatment of Recurrent Hemarthrosis Following Total Knee Arthroplasty Using Surgical Interventions

BackgroudRecurrent hemarthrosis following total knee arthroplasty (TKA) is a rare complication. Its pathophysiology and standard treatments have not yet been established. In this study, we report 7 cases of recurrent hemarthrosis after TKA in which failure of the initial conservative treatment was followed by angiographic embolization; in 1 of the 7 cases, arthroscopic electrocauterization was also performed after treatment failure with selective embolization.MethodsFrom January 2015 to May 2018, 7 patients visited our hospital due to recurrent hemarthrosis after TKA. Their medical records and serologic test results were reviewed to check for the presence of any bleeding disorder and history of anticoagulant use. Implant malalignment and instability were checked using X-ray. In all cases, the conservative treatment failed, so interventional angiography with selective embolization was performed, which was also followed by arthroscopic electrocauterization if the outcome was unsatisfactory.ResultsThe interval between TKA and the onset of hemarthrosis ranged from 3 to 76 months (average, 34.1 months). There was no coagulopathy and instability. All patients underwent conservative treatment at an interval of 4.3 months and the rate of relapse was 3.1 on average. On the interventional angiography, 6 cases showed vascular blush, and 1 case had pulsatile bleeding. The average duration for interventional angiography was 90.9 minutes. The average length of follow-up was 38.8 months. Embolization was successfully performed in 4 cases. In 2 of 3 failed cases, the symptoms improved without further treatment. In the remaining 1 failed case, the patient had a relapse of hemarthrosis, so an arthroscopic procedure was performed, which led to identification of the suspicious bleeding point by using preoperative angiographic findings. Electrocauterization was performed and active bleeding was stopped. All cases with recurrent hemarthrosis achieved improvement.ConclusionsInterventional angiography was used to aid in the diagnosis of recurrent hemarthrosis, and therapeutic selective embolization provided satisfactory clinical results. Even if selective embolization fails, interventional angiography may be helpful for further surgical procedures because it reveals vascular blush of a bleeding site. Therefore, interventional angiography and selective embolization should be considered to be a useful treatment for recurrent hemarthrosis after TKA.     

Culture-Expanded Autologous Adipose-Derived Mesenchymal Stem Cell Treatment for Osteonecrosis of the Femoral Head

BackgroudOutcomes of traditional treatment for osteonecrosis of the femoral head (ONFH) are not always satisfactory. Hence, cell-supplementation therapy has been attempted to facilitate necrotic-tissue regeneration. Adipose-derived mesenchymal stem cell (ADMSC) transplantation is potentially advantageous over bone marrow-derived MSC implantation, but its outcomes for ONFH remain unclear. The aim of this study was to determine 2-year radiological and clinical outcomes of culture-expanded autologous ADMSC implantation for ONFH.MethodsEighteen hips with necrotic lesions involving ≥ 30% of the femoral head were included. ADMSCs were harvested by liposuction and culture expanded for 3 passages over 3 weeks. With a 6-mm single drilling, ADMSCs were implanted into the necrotic zone. All patients underwent magnetic resonance imaging (MRI), single-photon emission computed tomography/computed tomography (SPECT/CT) at screening and 6 months, 12 months, and 24 months postoperatively. The primary outcome was the change in the size of necrotic area on MRI. Secondary outcomes were changes in clinical scores and radioisotope uptake on SPECT/CT. Conversion total hip arthroplasty (THA) was defined as the endpoint.ResultsPreoperatively, the necrotic lesion extent was 63.0% (38.4%–96.7%) of the femoral head. The mean Harris hip score was 89.2, the University of California at Los Angeles (UCLA) score was 5.6, and Western Ontario and McMaster Universities Arthritis index (WOMAC) was 79.4. Three patients underwent THA and 1 patient died in an accident. Finally, 11 patients (14 hips) were available for ≥ 2-year follow-up. At the last follow-up, no surgery-related complications occurred, and 14 of 17 hips (82%) were able to perform daily activities without THA requirement. There was no significant decrease in lesion size between any 2 intervals on MRI. However, widening of high signal intensity bands on T2-weighted images inside the necrotic lesion was observed in 9 of 14 hips (64%); 11 of 14 hips (79%) showed increased vascularity on SPECT/CT at 2 years postoperatively. No significant differences were observed between preoperative and 24-month mean Harris hip score (89.2 vs. 88.6), WOMAC (79.4 vs. 75.7), and UCLA score (5.6 vs. 6.2).ConclusionsOur outcomes suggest that culture-expanded ADMSC implantation is a viable option for ONFH treatment without adverse events.     

An aqueous extract of Platycodi radix inhibits LPS-induced NF-kappaB nuclear translocation in human cultured airway epithelial cells

We investigated the effects of aqueous extract from Platycodi radix (AEPR), a traditional drug used to treat acute lung inflammatory disease, on lipopolysaccharide (LPS)-induced inflammation in A549 human cultured airway epithelial cells. Nuclear factor-kappaB (NF-kappaB) and its inhibitory regulator, inhibitory kappaB (I-kappaB), play crucial roles in LPS-induced inflammatory response. We show that LPS-induced nuclear translocation of NF-kappaBp65 is inhibited by AEPR. LPS-induced expression of I-kappaBalpha, which is expressed by LPS-induced activation of NF-kappaB, is inhibited by AEPR as well. Besides LPS-induced expression of a group of genes, such as tumor necrosis factor-alpha (TNF-alpha), inducible nitric oxide synthase (iNOS) and cyclooxygenase-2 (COX-2), are repressed by AEPR. We also found that expression of heat shock protein 70 (Hsp70), which has an anti-inflammatory activity, is increased by AEPR plus LPS. These results suggest that AEPR may act as a therapeutic agent for inflammatory disease through regulating the activity of NF-kappaB and expression of inflammatory genes.     

Problem case: two-dimensional enlargement of the upper lip after excision of a vascular malformation

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Problem case: two-dimensional enlargement of the upper lip after excision of a vascular malformation     

基因芯片对PMA激活的血管内皮细胞早期反应基因的研究

目的 :用基因芯片研究 PMA激活的血管内皮细胞的早期反应基因 (imm ediate early response gene,ERG)。方法 :以包含 40 96条人类基因的 DNA芯片检测血管内皮细胞受代谢增强剂 PMA(phorbol myristate acetate)激活后早期的基因表达谱 ,并从中筛查出 ERG。结果 :血管内皮细胞受 PMA作用 6 h后 ,17条基因上调 ,11条下调。数据处理聚类分析表明 17条上调基因中多数 (13/ 17)属蛋白质磷酸酶和转录调控因子基因 ,而下调基因中多数 (9/ 11)为细胞分裂相关基因。结论 :证明PMA激活的人血管内皮细胞早期反应基因主要是转录调控因子和蛋白质磷酸酶基因。     

图形设计中的写意造型

中国画的写意造型 ,展示的是似与不似之间、寓意于象、以象尽意“心物统一”的意象。在图形设计中采用写意造型方法 ,能使设计意念的表达更显符号化与象征性 ,同时也丰富观者感受层面与审美经验。     

不同地区妇女产褥期卫生行为研究

目的 了解江苏、陕西和贵州三省妇女产褥期卫生行为和保健的一般情况;比较 不同地区间产褥期各种卫生行为的发生率;了解影响产褥期卫生行为的相关因素。方法 用问卷调查的形式对三者１２个县的２３５２例２岁以下儿童母亲进行入户访问。结果 江苏、陕西、贵州三者产褥期各卫生行为的发和衣次为：洗头２６．４％,３８．８％,１９．８％, 下身（指外阴部,下同）８３．３％,２６．９％,６４．０％,正常活动７６．９％,７     

McAb共刺激PBLs淋巴细胞在培养体系中的状态及超微结构的 …

通过用抗ＣＤ３,ＣＤ２８＋ＣＤ８０ ＭｃＡｂ激活健康人的ＰＢＬｓ,并以ＰＨＡ,ＩＬ－２,ＰＢＬｓ为对照组;对各组不同时间段的淋巴细胞超微结构进行观察。结果提示：ＣＤ３及ＣＤ２８＋ＣＤ８０刺激淋巴细胞增殖外,也能使淋巴细胞活化,细胞表现为胞体增大,细胞器增多,具有粗大的绒毛和突出伪足,并可见单核细胞吞噬活跃。     

A rubrofusarin gentiobioside isomer from roastedCassia tora

From the roasted seeds ofCassia tora L., a new naphthopyrone glycoside was isolated and characterized as 10-[(β-D-glucopyranosyl-(1→6)-O-β-D-glucopyranosyl)oxyl-5-hydroxy-8-methoxy-2-methyl-4H-naphtho [1,2-b]pyran-4-one(isorubrofusarin gentiobioside). Along with isorubrofusarin gentiobioside, alaternin and adenosine were isolated and identified.