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.     

软骨组织工程种子细胞的基础和应用研究进展

软骨种子细胞的老化和缺乏是限制软骨组织工程在临床应用的瓶颈问题。本文概述了目前对软骨种子细胞研究的两个方面 :扩大种子细胞的来源及预防和延缓种子细胞功能老化 ,并展望软骨组织工程在监床的应用前景。     

气功外气对人鼻咽癌细胞株的抑制作用和DNA合成影响的初步探讨

为寻找祖国医学治疗鼻咽癌的新途径,我们进行了气功外气对体外培养的人鼻咽低分化鳞癌细胞株(CNE—2)的抑制作用试验,实验共进行了三次,光镜观察受功组比对照组生长缓慢,外气对细胞生长的抑制率分别为33％(P<0.05);43％(P<0.05);55％(P<0.001)。同时进行了~3H—TdR掺入试验,观察外气对CNE—2细胞株DNA合成的影响。实验进行了四次,其抑制率分别为:34％(P<0.01);35％(P<0.01);39％(P<0.01),53％(P<0.001),模仿者为17％(P>0.05)。     

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     

口腔颌面鳞癌术前诱导化疗二种方式临床疗效分析

目的 :探讨口腔颌面鳞癌术前诱导化疗二种方式应用的疗效、主要毒副反应差别 ,以及临床适应证。为术前诱导化疗的选择提供临床指导。方法 :本文回顾了 1 0 4例可评价近期疗效的口腔颌面鳞癌术前诱导化疗的病例。其中全身化疗 5 6例 ,颈外动脉插管化疗 48例。结果 :以肿瘤体积缩小 5 0 %以上作为化疗有效指标 ,全身化疗组有效率为 6 4.3%。颈外动脉插管化疗组有效率为79.2 % ,两组总有效率为 71 .2 % (P<0 .0 5 )。全身化疗组的主要毒副反应为胃肠反应、白细胞减少和脱发 ;颈外动脉插管化疗组主要为口腔粘膜溃疡、糜烂及灼痛感。结论 :作为术前诱导的全身化疗较适合于全身状况良好的患者 ,而颈外动脉插管灌注化疗较适合于全身状况稍差、无转移、肿瘤范围不广的患者。     

NADPH氧化酶家族在心血管疾病中作用的研究进展

烟酰胺腺嘌呤二核苷酸磷酸氧化酶是心血管系统中活性氧(reactive oxygen species,ROS)的主要来源,它包 括7种亚型并分别表达在不同的心血管细胞及其细胞器中,参与调节细胞增殖、迁移、分化、凋亡、衰老和炎症反应 等多种活动,其衍生的ROS参与高血压、动脉粥样硬化、糖尿病血管病变、心肌梗死后心室重构等多种心血管疾病 的病理过程。     

多通道人工耳蜗在语前聋儿童及青少年中的应用

目的　通过对植入人工耳蜗的语前聋儿童和青少年的听力和语言能力的评估 ,探讨我国儿童在使用人工耳蜗后的听力和言语能力发展规律及影响因素。方法　 2 5例行人工耳蜗植入的语前聋儿童及青少年患者参与本组测试。选用《聋儿听觉言语康复评估方法》作为测试材料 ,分别进行声音、言语声和环境声的辨别 ,数词、单字词、双字词、3字词、韵母、声母、声调、封闭项列短句的识别 ,开放项列字词和开放项列短句识别 ,语言清晰度 ,模仿句长 ,听话识图和看图说话等方面测试。结果　受试者术后均能感知到声音 ,辨别不同类别的声音。封闭项列测试结果全部大于机会水平 ,正确识别率随人工耳蜗使用时间而不断增加 ,随植入时年龄的增长而呈下降趋势。术后约半年显现开放项列识别能力 ,使用人工耳蜗后对患儿的言语发育具有较大帮助。结论　尽早对语前聋患儿植入人工耳蜗及进行术后康复 ,以达改善听力 ,提高语言能力 ,促进身心全面发展的目的。