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    08 August 2019, Volume 23 Issue 22 Previous Issue    Next Issue
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    Application of electrospun polycaprolactone-polyethylene glycol-polycaprolactone fiber scaffolds in bone tissue engineering
    Fu Na, Luo Xiaoding, Jiao Tiejun, Sui Lei
    2019, 23 (22):  3445-3450.  doi: 10.3969/j.issn.2095-4344.1269
    Abstract ( 502 )   PDF (1079KB) ( 120 )   Save

    BACKGROUND: Polycaprolactone-polyethylene glycol-polycaprolactone (PCL-PEG-PCL) is a good scaffold material for tissue engineering. Little is reported on electrospun PCL-PEG-PCL in bone tissue engineering.

    OBJECTIVE: To prepare PCL-PEG-PCL scaffolds using electrospinning technology and investigate their physical/chemical/biological/ osteogenic properties.  

    METHODS: PCL-PEG-PCL scaffolds were prepared using electrospinning technology. Scaffold surface was characterized by scanning electron microscopy. The physical and chemical properties, such as the hydrophilic angle and Young’s modulus, of the scaffold were determined. Bone marrow mesenchymal stem cells were seeded on PCL-PEG-PCL scaffolds and cell morphology was observed. In the experimental group, bone marrow mesenchymal stem cells were seeded on PCL-PEG-PCL scaffolds and then cultured. In the control group, bone marrow mesenchymal stem cells were concurrently cultured without seeding on the PCL-PEG-PCL scaffolds. After culture for 1, 3, 5 days, cell proliferation was determined by the Cell Counting Kit-8 assay. After osteogenic induction for 1, 5, 7, and 14 days, the expression levels of osteogenic genes Runx2 and osteopontin were detected by fluorescence-based quantitative PCR. The study was approved by the Ethics Committee of West China School of Stomatology, Sichuan University (SKLODLL2013A173).

    RESULTS AND CONCLUSION: Electrospun PCL-PEG-PCL scaffold had a non-woven structure. Its fibers were continuous and had smooth surface without granular nodules. There was no obvious boundary between the fibers. The fibers were interwoven with each other to form a three-dimensional structure with different sized pores. The hydrophilic angle was (116.1±2.5)° and was relatively hydrophobic. The Young's modulus was 16.464 4 MPa. A large number of bone marrow mesenchymal stem cells adhered on the electrospun PCL- PEG-PCL scaffolds. Adjacent cells began to connect and fuse with each other, and some of them grew into the pore of the scaffold fibers. The proliferation speed of cells cultured at different time points in the experimental group was faster than that in the control group (P < 0.05). At 5, 7, 14 days of culture, Runx2 gene expression in the experimental group was significantly higher than that in the control group (P < 0.05). At 1, 5, 7, 14 days of culture, osteopontin expression in the experimental group was significantly higher than that in the control group (P < 0.05). These results suggest that electrospun PCL-PEG-PCL scaffolds exhibit encouraging physical/chemical/biological/osteogenic properties.

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    Bracketless invisible orthodontic appliance for treating adult periodontal disease
    Yang Baokuan, Huang Rui, Shi Xinghui
    2019, 23 (22):  3451-3455.  doi: 10.3969/j.issn.2095-4344.1271
    Abstract ( 20 )   PDF (868KB) ( 34 )   Save
    BACKGROUND: Bracketless invisible orthodontic appliance has been shown to be available for adult periodontal disease.
    OBJECTIVE: To compare the treatment efficacy between bracketless invisible orthodontic appliance and traditional method in adult periodontal disease.
    METHODS: One hundred and twenty cases of periodontal disease admitted at Affiliated Stomatological Hospital of Nanjing Medical University from January 2013 to August 2016 were enrolled, and randomized into observation group (n=60, bracketless invisible orthodontic appliance) and control group (n=60, traditional method). The gingival index, probing depth, sulcus bleeding index and plaque index before and after therapy were detected and the curative effect was assessed. The levels of C-reactive protein, tumor necrosis factor-α, interleukin-2 and interleukin-6 in the gingival crevicular fluid were measured. The study was approved by the Ethics Committee of Affiliated Stomatological Hospital of Nanjing Medical University, approval No. 201302036.
    RESULTS AND CONCLUSION: (1) The plaque index after therapy in the observation group was significantly lower than that in the control group (P < 0.05). The gingival index, probing depth, and sulcus bleeding index showed no significant difference between two groups (P > 0.05). (2) The total effective rate in the observation group (93.3%) was significantly higher than that in the control group (80.0%) (P < 0.05). (3) The levels of C-reactive protein, tumor necrosis factor-α, and interleukin-6 in the gingival crevicular fluid in the observation group were significantly lower than those in the control group (P < 0.05), and the level of interleukin-2 was significantly higher than that in the control group (P < 0.05). (4) In summary, the efficacy of bracketless invisible orthodontic appliance for treating adult periodontal disease is exact, and can effectively reduce the levels of inflammatory factors.
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    Osteogenic effects of hydroxyapatite/beta-tricalcium phosphate/chitosan/methylcellulose bone for maxillary sinus elevation
    Diao Zhaofeng, Li Xiaoliang, Ailimaierdan•Aniwear, Lin Cheng, Zhou Mei, Pan Xiaoling, Li Peng
    2019, 23 (22):  3456-3462.  doi: 10.3969/j.issn.2095-4344.1272
    Abstract ( 15 )   PDF (2683KB) ( 59 )   Save
    BACKGROUND: Three-dimensional scaffold material hydroxyapatite/β-tricalcium phosphate/chitosan/methylcellulose has been shown to exhibit good physical and chemical properties and biocompatibility.
    OBJECTIVE: To evaluate the osteogenic effects of injectable hydroxyapatite/β-tricalcium phosphate/chitosan/methylcellulose scaffold material compounded with bone marrow mesenchymal stem cells used for maxillary sinus elevation in rabbits.
    METHODS: Twenty-four New Zealand rabbits were provided by Laboratory Animal Center of Xinjiang Medical University, China and included in this study. Four maxillary sinus elevation areas were created in each rabbit. Injectable hydroxyapatite/β-tricalcium phosphate/chitosan/ methylcellulose scaffold compounded with bone marrow mesenchymal stem cell complex (experimental group), simple injectable hydroxyapatite/β-tricalcium phosphate/chitosan/methylcellulose scaffold (control group 1), or hydroxyapatite /β-tricalcium phosphate bone powder (control group 2) were implanted into three of the four maxillary sinus elevation areas. For blank control, no material was implanted in the last area. At 4, 8 and 12 weeks after surgery, maxillary sinus elevation area specimens were taken for cone-beam CT scanning, hematoxylin-eosin staining, and immunohistochemical staining. The experiments were approved by the Laboratory Animal Ethics Committee of the First Affiliated Hospital of Xinjiang Medical University (approval No. IACUC201706-02).
    RESULTS AND CONCLUSION: (1) Cone beam CT scanning showed that there was no newly formed bone in the blank control group, and new bone formed in the other three groups, in particular in the experimental group, at 8 weeks after surgery. A greater amount of bone formed in the experimental group, control group 1, and control group 2 at 12 weeks after surgery compared with the blank control group. There was no significant difference among three groups. (2) Hematoxylin-eosin staining showed that at 8 and 12 weeks after surgery, the osteogenic effect in the experimental group was superior to that in the control groups 1 and 2 (P < 0.05). (3) Immunohistochemical staining showed that at 8 weeks after surgery, the expression level of osteogenic markers bone morphogenetic protein 2 and vascular endothelial growth factor in the experimental group was higher than that in the control groups 1 and 2 (P < 0.05). At 12 weeks after surgery, there were no significant differences in the expression levels of bone morphogenetic protein 2 and vascular endothelial growth factor among three groups (P > 0.05).  (4) These results suggest that injectable hydroxyapatite/β-tricalcium phosphate/chitosan/methylcellulose scaffolds can promote the bone formation in the maxillary sinus elevation areas.
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    Bone grafting with recombinant human bone morphogenetic protein-2 or autologous platelet-rich plasma versus simple bone grafting for repair of bone defects
    Li Shuyuan, Zhou Qishi, Li Yue, Chen Chao, Chen Jiaqi, Zhou Hongliang, Yang Jiabao
    2019, 23 (22):  3463-3468.  doi: 10.3969/j.issn.2095-4344.1270
    Abstract ( 19 )   PDF (996KB) ( 31 )   Save
    BACKGROUND: Both bone morphogenetic protein-2 and platelet-rich plasma can promote bone healing. However, little is reported on application of bone morphogenetic protein-2 or platelet-rich plasma to induced membrane technique in basic research and clinical studies.  
    OBJECTIVE: To investigate the clinical efficacy of bone grafting with recombinant human bone morphogenetic protein-2 or autologous platelet-rich plasma versus simple bone grafting in the repair of bone defects during a phase II surgery using induced membrane technique.
    METHODS: 59 patients with bone defects who received treatment in the First Affiliated Hospital of Guangzhou University of Chinese Medicine during January 2013-January 2018 were included in this study. Following phase I surgery with induced membrane technique, these patients were assigned to receive phase II surgery: autologous bone grafting with recombinant human bone morphogenetic protein-2 (group A, n=20), autologous bone grafting with autologous platelet-rich plasma (group B, n=21), autologous bone grafting (group C, n=18). Postoperative complications (recurrent infection, joint stiffness, muscle atrophy, persistent pain, etc.) were recorded. Bone healing time and osteophyte score were evaluated by X-rays. This study was approved by the Ethics Committee of the First Affiliated Hospital of Guangzhou University of Chinese Medicine, China.
    RESULTS AND CONCLUSION: (1) All 59 patients were followed up for 11-40 months. (2) The average bone healing time was (29.30±4.54), (28.71±5.37), and (35.50±7.37) weeks in the groups A, B and C, respectively. The average bone time in the groups A and B was significantly shorter than that in the group C (P < 0.05). (3) At 6 months after surgery, the osteophyte scores in the groups A and B were significantly higher than those in the group C (9.50±1.43, 9.14±0.85, 7.83±1.42, P < 0.05). (4) There were two cases of deep infection and one case of bone resorption in the group A. There was one case of deep infection and one case of residual knee stiffness with moderate pain in the group B. There were four cases of infection, three cases of bone resorption, delayed healing and one case of residual knee stiffness and muscle atrophy in the group C. The number of complications in the groups A and B was significantly less than that in the group C (P < 0.05). (5) The results suggest that application of bone morphogenetic protein-2 or autologous platelet-rich plasma to phase II induced membrane technique for repair of bone defects can accelerate bone healing and obtain encouraging repair efficacy with a few postoperative complications.  
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    External fixation of thermoplastic plate brace versus gypsum for treating Colles fracture: a randomized controlled trial
    Kong Changgeng, Wu Duoqing, Fu Linxiong, Huang Youhua, Wang Congren
    2019, 23 (22):  3469-3474.  doi: 10.3969/j.issn.2095-4344.1752
    Abstract ( 553 )   PDF (2466KB) ( 88 )   Save
    BACKGROUND: The new medical thermoplastic plate brace has been widely used for the external fixation of limb fractures, and has achieved some curative effects. But there is still no prospective randomized controlled study on its efficacy in the distal radius fractures needing for manual reduction.
    OBJECTIVE: To compare the clinical efficacy of manual closed reduction thermoplastic plate brace and gypsum external fixation in the treatment of Colles fracture by prospective randomized control.
    METHODS: One hundred and twenty patients with Colles fractures from January 2016 to January 2018 at the Department of Orthopedics, Central South University Xiangya School of Medicine Affiliated Haikou Hospital were enrolled, including 52 males and 68 females, aged 18-65 years. The patients were randomly divided into two groups and treated with manual closed reduction and thermoplastic plate brace external fixation (thermoplastic plate group, n=60) and manual closed reduction gypsum external fixation (gypsum group, n=60). The complications during treatment were recorded. At 3 and 6 months after treatment, the Visual Analog Scale scores were assessed. At 6 months after treatment, the Gartland-Werley scoring system was used to assess the wrist function and to assess patient satisfaction. Imaging assessment of reduction and fracture healing was performed at immediately, 6 weeks and 6 months after treatment. The study was approved by the Ethics Committee of Central South University Xiangya School of Medicine Affiliated Haikou Hospital, approval number: 2014-308.
    RESULTS AND CONCLUSION: (1) The incidence of reactions to the host in the thermoplastic plate group was lower than that in the gypsum group (13.3%, 36.7%, P < 0.05). (2) The Visual Analog Scale scores at 3 and 6 months after treatment in the thermoplastic plate group were lower than those in the gypsum group (P < 0.05). (3) The excellent rate of wrist function and patient satisfaction in the thermoplastic plate group were higher than those in the gypsum group (excellent rate: 88.3%, 73.3%; satisfaction: 91.7%, 65.0%, P < 0.05). (4) The imaging examination showed that the radial height, palmar tilt angle, and ulnar inclination angle in the two groups were significantly better than before treatment, and there was no significant difference between two groups (P > 0.05). (5) These results show that the use of thermoplastic plate brace and gypsum external fixation for treating Colles fracture can obtain satisfactory reduction effect, but the thermoplastic plate has the advantages of simple operation, low incidence of complications, good recovery of wrist function and high patient satisfaction.
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    Clinical efficacy of high viscosity bone cement vertebroplasty for treating osteoporotic vertebral compression fractures
    Fang Genqiang, Zhao Zhengli, Jin Xianhui, Zhang Qingsheng, Cui Shengjie, Wei Wei, Yan Guanghui, Wu Jiaqi, Zhao Lei
    2019, 23 (22):  3475-3480.  doi: 10.3969/j.issn.2095-4344.1273
    Abstract ( 32 )   PDF (978KB) ( 43 )   Save
    BACKGROUND: Studies have confirmed that the use of high viscosity bone cement for vertebroplasty can significantly reduce the risk of bone cement leakage.
    OBJECTIVE: To study the clinical effect of high viscosity bone cement vertebroplasty in the treatment of osteoporotic vertebral compression fractures.
    METHODS: From October 2014 to February 2017, 200 patients with osteoporotic vertebral compression fractures were enrolled at the Department of Osteopathy, Hengshui City People’s Hospital, including 82 males and 118 females, aged 60-82 years. The patients were randomly divided into two groups: trial group (n=100, high viscosity bone cement for vertebroplasty) and control group (n=100, low viscosity bone cement for vertebroplasty), and the bone cement leakage intraoperatively was recorded. The Visual Analog Scale score, low back pain dysfunction index score and SF-36 score were used to evaluate the improvement of clinical symptoms at baseline and 3 months and 1 year after surgery. The height recovery and Cobb angle of the injured vertebrae were evaluated by imaging examination. The study was approved by the Ethics Committee of Harrison Internal Peace Hospital, approval number: 2015-2-003.
    RESULTS AND CONCLUSION: (1) The incidence of bone cement leakage in the trial group was significantly lower than that in the control group (10%, 27%, P=0). (2) At 3 months and 1 year after surgery, the Visual Analog Scale score and low back pain dysfunction index scores in both groups were significantly lower than those at baseline, and the SF-36 score was significantly higher than that at baseline (P < 0.05). All above scores showed no significant difference between two groups (P > 0.05). (3) The height and Cobb angle of the injured vertebrae in both groups were significantly improved compared with those at baseline (P < 0.05), and there was no significant difference in the height and Cobb angle of the injured vertebrae between two groups (P > 0.05). (4) These results indicate that both high viscosity bone cement and low viscosity bone cement vertebroplasties have good clinical effect in the treatment of osteoporotic vertebral compression fracture, but the risk of bone cement leakage is low when high viscosity bone cement is used.
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    Unipedicular percutaneous vertebroplasty versus percutaneous kyphoplasty bone cement for treating Kummell disease
    Jiang Jie, Zhang Yong
    2019, 23 (22):  3481-3487.  doi: 10.3969/j.issn.2095-4344.1274
    Abstract ( 17 )   PDF (1073KB) ( 36 )   Save
    BACKGROUND: Percutaneous vertebroplasty and percutaneous kyphoplasty are effective minimally invasive treatments for type I or II Kummell disease, but it is still unclear which treatment is better.
    OBJECTIVE: To compare the clinical efficacy of unipedicular percutaneous vertebroplasty and percutaneous kyphoplasty in the treatment of type I or II Kummell disease.
    METHODS: Fifty-one patients with Kummell disease were admitted at the Department of Orthopedics, the Central Hospital of Yongzhou from January 2014 to September 2017, including 14 males and 37 females, aged 60-89 years old, responsible for T10-L3. Of which, 27 patients underwent unilateral puncture vertebroplasty with cement injection, and 24 patients underwent unilateral puncture kyphoplasty with cement injection. Intraoperative and postoperative cement leakage, transient fever and re-fracture were recorded. Before treatment, 1 day after treatment and at the last follow-up, the height of the vertebral body of the injured vertebrae and the Cobb angle were evaluated by imaging. Visual Analogue Scale and Oswestry dysfunction index were assessed before treatment and 1 day, 1, 6 and 12 months after treatment. The study was approved by the Ethics Committee of the Central Hospital of Yongzhou, Hunan Province.
    RESULTS AND CONCLUSION: (1) There was no significant difference in the occurrence of cement leakage, transient fever and re-fracture between two groups (P > 0.05). (2) The height of the anterior edge of the injured vertebral body and the Cobb angle in the two groups were significantly improved after treatment (P < 0.05), and the improvement in the puncture kyphoplasty group was better than that in the puncture vertebroplasty group (P < 0.05). (3) The Visual Analogue Scale and Oswestry dysfunction index scores after treatment in the two groups were lower than those before treatment (P < 0.05). There was no significant difference in the scores between two groups (P > 0.05). (4) These results show that percutaneous kyphoplasty or percutaneous vertebroplasty can significantly alleviate the pain of patients with Kummell disease and obtain good effectiveness and safety. In contrast, percutaneous kyphoplasty can achieve better imaging height and Cobb angle reduction.
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    Orthodontic micro-implant stability under continuous or intermittent loading: a histomorphometric and biomechanical evaluation
    Wu Yeke, Gao Ranran, Zhao Lixing
    2019, 23 (22):  3488-3494.  doi: 10.3969/j.issn.2095-4344.1275
    Abstract ( 26 )   PDF (2501KB) ( 78 )   Save
    BACKGROUND: During the orthodontic treatment process, many scholars believe that intermittent force can achieve the same or even greater effect of tooth movement than persistent force, and reduce the occurrence of root resorption and other adverse reactions. However, the above conclusions are mostly from in vitro cell experiments or clinical case study, and there is still a lack of scientifically designed and large-scale animal experiments.
    OBJECTIVE: To evaluate the influence of continuous or intermittent force of two modes on osseointegration and biostability of orthodontic micro-implant.
    METHODS: Forty-eight beagles (provided by Laboratory Animal Center of Sichuan University) were selected and mini-implants were implanted bilaterally in intraradicular zones of mandibular first molar and second premolar. The beagles were randomly allotted into four groups: loadings were delivered consecutively in continuous group, and pauses were given for the last 3 or 7 days of each reactivation period for intermittent group A and B, respectively. The group unloaded served as control. Loading protocol and period: loading force was applied by installing nickel-titanium closed coil springs on two mini-implants with ligating wires, and 2-week was set as a loading period, for 4 periods. After 2, 4, 6 and 8 weeks, the mandible tissues were obtained for micro-CT, histological observation and pull-out test. The study was approved by the Experimental Animal Ethics Committee of Sichuan University.
    RESULTS AND CONCLUSION: (1) The values of peak load at extraction (Fmax) at various loading time points in the control group were higher than those in the continuous group (P < 0.05). Fmax of the intermittent group B was higher than that in the continuous group at week 2, 4 and 6 (P < 0.05); and the Fmax at week 2 in the intermittent group A was higher than the continuous group (P < 0.05). (2) At the same loading time point, the ossointegration, bone volume/tissue volume and intersection surface in the unloaded control were higher than those in the continuous group (P < 0.05). The ossointegration and bone volume/tissue volume in the intermittent group B at 2, 4, 6 and 8 weeks were higher than those in the continuous group (P < 0.05). At 2, 4 and 6 weeks, the intersection surface was higher than in the continuous group  (P < 0.05). The ossointegration in the intermittent group A at 2 and 4 weeks was higher than that in the continuous group (P < 0.05).The bone volume/tissue volume was higher than in the continuous group at 2, 4 and 6 weeks (P < 0.05). The intersection surface was higher than in the continuous group at 2 weeks (P < 0.05). (3) Bone remodeling was observed in all groups after 8 weeks of loading, and the bone remodeling was best in the unloaded control group, followed by intermittent groups B and A and poorest in the continuous group. (4) In summary, intermittent loading regimen is more favorable for obtaining stability than continuous force, and the 7-day/7-day loading cycle is more beneficial for bone-implant integration than the 11-day/3-day protocol.
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    Inhibitory effects of nanosilver sponge with Danhuang powder on Pseudomonas aeruginosa 
    Li Tao, Zhang Chunling, Long Yi, Di Tietao, Chen Lu, Zhao Wei, Long Li, Huang Qiang, Tang Lisha, Luo Kaizhong
    2019, 23 (22):  3495-3499.  doi: 10.3969/j.issn.2095-4344.1276
    Abstract ( 17 )   PDF (1547KB) ( 56 )   Save
    BACKGROUND: Danhuang powder has been recently shown to promote the healing of diabetic foot ulcers, but its antibacterial activity is not satisfactory. Therefore, broad-spectrum antibacterial nanosilver sponge is loaded with Danhuang powder for clinical application. OBJECTIVE: To investigate the antibacterial activity of nanosilver sponge with Danhuang powder against Pseudomonas aeruginosa.
    METHODS: Nanosilver sponge with Danhuang powder containing 22.22%, 16.67%, 11.11% silver nitrate (Danhuang-nanosilver group) and simple nanosilver sponge containing 22.22%, 16.67%, 11.11% silver nitrate (simple nanosilver group) were cut into round pieces (1 cm in diameter) and placed on Pseudomonas aeruginosa suspension-spread culture medium. Paper sheets of the same size were dipped in the imipenem-cilastatin aqueous solution (imipenem-cilastatin group) and then also positioned on Pseudomonas aeruginosa suspension-spread culture medium for positive controls. For negative controls, chitosan sponge of the same size was used (chitosan group). All tested materials were cultured in an incubator at 35 °C for 24 hours, and the size of the inhibition zone was compared.
    RESULTS AND CONCLUSION: The antibacterial activity against Pseudomonas aeruginosa in the imipenem-cilastatin group was superior to that in the Danhuang-nanosilver, simple nanosilver, chitosan groups (P < 0.05). The antibacterial activity against Pseudomonas aeruginosa in the Danhuang-nanosilver and simple nanosilver groups was superior to those in the chitosan group (P < 0.05). The antibacterial activity against Pseudomonas aeruginosa was similar between Danhuang-nanosilver and simple nanosilver groups at the same concentration of silver nitrate (P > 0.05). There was no significant difference in the antibacterial activity against Pseudomonas aeruginosa between different concentrations of silver nitrate in the simple nanosilver and Danhuang-nanosilver groups (both P > 0.05). These results suggest that nanosilver sponge with Danhuang powder exhibits antibacterial activity against Pseudomonas aeruginosa, showing unique advantages in the treatment of diabetic foot ulcers.
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    Osteogenic property of beta-tricalcium phosphate/alpha-calcium sulphate hemihydrate combined bone graft in multi-segment posterolateral arthrodesis of rabbit thoracic vertebrae
    Liang Maohua, Mao Keya, Xia Bo, Liu Qiang,Tang Peifu, Wang Jifang
    2019, 23 (22):  3500-3505.  doi: 10.3969/j.issn.2095-4344.1277
    Abstract ( 32 )   PDF (2301KB) ( 30 )   Save
    BACKGROUND: Preliminary studies have revealed that β-tricalcium phosphate/α-calcium sulphate hemihydrate combined bone graft has ideal biomechanical strength and degradation performance in vitro.
    OBJECTIVE: To observe the new bone formation and resorption of β-tricalcium phosphate/α-calcium sulphate hemihydrate combined bone graft in rabbit models of multi-segment posterolateral arthrodesis of thoracic vertebrae.
    METHODS: Thirty-six male New Zealand white rabbits (provided by Experimental Animal Center of General Hospital of PLA) were selected and their superior/inferior articular processes, bilateral vertebral plate and transverse processes of T4-T8 were removed. β-Tricalcium phosphate/α-calcium sulphate hemihydrate combined bone grafts were transplanted into the right side (experimental group), and autologous bone was transplanted into the another side (control group). Tetracycline hydrochloride was injected through vein as fluorescent mark 13 and 3 days before the rabbits were euthanized. Thoracic segments of spine were removed at 4, 8 and 12 weeks postoperatively. Tetracycline hydrochloride staining was used to observe the morphology of newly formed bones. Molybdenum soft X-ray was used for morphological observation and histological observation was conducted. The experimental protocol was approved by the Animal Ethics Committee of General Hospital of PLA, approval number: 201511007.
    RESULTS AND CONCLUSION: (1) The new bone mineral appositional rate of graft materials in the two groups decreased with time, and peaked at the end of postoperative 4 weeks. The new bone mineral appositional rate in the graft area at postoperative different time points in the experimental group was lower than that in the control group (P > 0.05). (2) Mammography revealed that the contours of combined bone grafts and boundaries between graft and bones were clear at the end of postoperative 4 weeks, but contours of combined bone grafts were blurred at the end of postoperative 8 weeks and the new bones grew into scaffolds of combined bone grafts. The graft materials were crawling substituted by new bones at the end of postoperative 12 weeks, and there were only small amount of remains at the central of graft sites. (3) Giemsa staining showed that combined bone graft materials degraded gradually, and were surrounded by new bone over time; these materials had completely degraded into fine fragments by the end of 12 weeks after operation. (4) Our results indicate that β-tricalcium phosphate/α-calcium sulphate hemihydrate combined graft in the multi-segment posterolateral arthrodesis of rabbit thoracic vertebrae holds good osteogenic property and degradation property.
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    Novel absorbable cannulated screw combined with non-absorbable suture-tension band versus traditional advanced tension band for treating patellar fractures
    Lin Yipeng, Yue Kai, Xu Yingshu, Li Qi, Huang Xihao, Li Jian
    2019, 23 (22):  3506-3511.  doi: 10.3969/j.issn.2095-4344.1278
    Abstract ( 14 )   PDF (1008KB) ( 39 )   Save
    BACKGROUND: For transverse patella fractures, traditional advanced tension band possesses the risk for secondary surgery, which needs long-term rehabilitation. Kirschner wire or steel wire may pierce the skin and cause pain, so the treatment scheme needs to be improved.
    OBJECTIVE: To compare the clinical efficacy of absorbable cannulated screw combined with non-absorbable suture-tension band and traditional advanced tension band for treating patella fractures.
    METHODS: Clinical data of 49 patients with transverse patella fractures were analyzed retrospectively, including 16 cases of absorbable cannulated screw combined with non-absorbable suture-tension band (group A) and 33 cases of modified traditional tension band (group B). All patients signed the informed contents, and the study was approved by the ethics committee of the hospital. The time of returning normal activity and hospitalization cost were compared. The anteroposterior and lateral film of the knee joint at postoperative 1 day, 3 and 6 months, and the Lysholm and International Knee Documentation Committee scores at baseline, postoperative 6 and 12 months were compared.
    RESULTS AND CONCLUSION: (1) Both groups showed improved Lysholm and International Knee Documentation Committee scores at baseline, postoperative 6 and 12 months (P < 0.001). The scores at postoperative 6 months in the group A were significantly higher than those in the group B (P < 0.001). There was no significant difference in the scores at postoperative 12 months between two groups (P > 0.05). (2) The time of returning normal activity in the group B was significantly longer than that in the group A (P=0.03). (3) The average hospitalization cost in the group A was ¥7 833 (¥8 000-10 000), and ¥11 769 (¥10 000-20 000) in the group B (P < 0.05). (4) At postoperative 1 day, the X-ray films showed a good alignment and no obvious dislocation, and articular surface was smooth and flat in both groups. At postoperative 3 months, the group A showed obscure fracture line and the obscure nail cap on the X-rays. Fracture line disappeared and the nail cap was invisible in the group A at postoperative 6 months. In the group B, detachment of the wire and needle was observed at postoperative 3 months. (5) In summary, compared with the traditional advanced tension band, the novel absorbable cannulated screw combined with non-absorbable suture-tension band exerts better clinical outcomes in the treatment of transverse patellar fractures, which is considered as an alternative method.
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    Pure titanium rib plate fixation treats rib facture: pain analysis compared with conservative treatment
    Wang Zuopei, Xie Xinjie, Sheng Bo, Ding Yi, Lu Yi, Cheng Mengqi
    2019, 23 (22):  3512-3517.  doi: 10.3969/j.issn.2095-4344.1260
    Abstract ( 12 )   PDF (846KB) ( 36 )   Save
    BACKGROUND: Existing studies have shown that open reduction and internal fixation is superior to the conservative treatment. However, due to the poor understanding of new concept of rib fracture and lack of high-quality evidence, the application in the treatment of rib fracture remains controversial.  
    OBJECTIVE: To investigate the effect of titanium rib plate fixation in the treatment of rib fracture on pain relief.
    METHODS: One hundred and eighty-seven cases of rib fractures were selected, and then allocated into surgical (n=79) and conservative (n=108) groups. The surgical group was given thoracoscopy-assisted small incision or traditional incision pure titanium rib plate fixation under anesthesia with double lumen tube and artery and central vein catheterized. All surgeries were completed within 1 week after trauma, 68 cases completed within 3 days (86%), and 11 cases were completed within 3-7 days (14%). The number and parts of rib fractures, hemopneumothorax and chest tube placement were recorded. The pain scores in the surgical (preoperative 1 day, postoperative 1 and 2 days) and conservative (1 and 2 days post-injury) groups were detected and compared.
    RESULTS AND CONCLUSION: (1) No case died in both groups. There were two cases of incision infection in the surgical group, and the sinus canal communicated with the plate after long-term dressing. The plate was removed at postoperative 34 and 42 days, and the wound was healed. The remaining patients discharged successfully or underwent other trauma treatment. (2) There were 468 (5.92±2.17 mean) fractured ribs in the surgical group, and 382 fractured parts (6.92±2.91 mean). There were 373 (3.45±1.38 mean) fractured ribs in the conservative group, and 382 fractured parts (3.54±1.54 mean). There was significant difference in the number and parts of rib fracture between two groups (both P < 0.01). (3) The pain score showed significant difference between conservative (908, 2.86±0.36) and surgical (400, 2.13±0.41) groups (P < 0.01), suggesting that the pain was significantly alleviated in the surgical group compared with the conservative group. (4) The single day score in the surgical group was significantly lower than that in the conservative group (P < 0.05). In the surgical group, the pain score at postoperative 1 day was significantly higher than that at postoperative 2 days (P < 0.01). (5) In summary, pure titanium rib plate fixation can effectively alleviate the pain of rib facture within 1 week after trauma.
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    Long-term effects of inorganic osteogenesis-inducing scaffold versus autologous bone in lumbar interbody fusion: protocol for a non-randomized, controlled trial with 2-year follow-up 
    Xue Zhixing, Zhou Jianwei, Chi Cheng, Wang Fei, Ma Yuquan
    2019, 23 (22):  3518-3521.  doi: 10.3969/j.issn.2095-4344.1751
    Abstract ( 9 )   PDF (652KB) ( 40 )   Save
    BACKGROUND: Preliminary study has shown that inorganic osteogenesis-inducing scaffold material exhibits good biocompatibility and bone-inducing effects in posterior lumbar interbody fusion, with encouraging short-term outcomes.
    OBJECTIVE: To investigate the safety and long-term effects of inorganic osteogenesis-inducing scaffold materials versus autologous ilium in lumbar interbody fusion.
    METHODS: This prospective, single-center, non-randomized, controlled trial will include 120 patients who receive treatment for lumbar degenerative diseases at the Department of Orthopedics, Beijing Tongren Hospital, Capital Medical University, China. These patients will receive lumbar repair surgery with inorganic osteogenesis-inducing scaffold materials (test group, n=60, 50%) or autologous ilium (control group, n=60, 50%). All patients will be followed up at 1 week, and 1 and 2 years postoperatively. This study was approved by the Medical Ethics Committee, Beijing Tongren Hospital, Capital Medical University, China (approval No. TRECKY2017-158) on September 28, 2017. Study protocol version: 1.0. All participants or their family members must provide written informed consent after fully understanding the study protocol. The study was registered with Chinese Clinical Trial Registry on February 15, 2019 (registration number: ChiCTR1900021333). Study protocol version: 1.0. Patient recruitment bengun and the results will be disseminated through presentations at scientific meetings.
    RESULTS AND CONCLUSION: The primary outcome measure of this study is the Oswestry Disability Index at 2 years postoperatively. The secondary outcome measures are the Oswestry Disability Index preoperatively and at 1 week and 1 year postoperatively, the Visual Analog Scale score, Japanese Orthopedic Association score, and lumbosacral angle preoperatively and at 1 week, and 1 and 2 years postoperatively, and the incidence of adverse reactions at 1 week, and 1 and 2 years postoperatively. This study will provide evidence to validate whether inorganic osteogenesis-inducing scaffold material results in similar long-term outcomes to autologous ilium in lumbar interbody fusion.
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    Infiltration resin versus microabrasion technique for repairing white spot lesions after orthodontics
    Nie Tinghong, Sun Yingchun, Gao Lirong, Song Guanjie
    2019, 23 (22):  3522-3529.  doi: 10.3969/j.issn.2095-4344.1739
    Abstract ( 60 )   PDF (1015KB) ( 59 )   Save
    BACKGROUND: Infiltration resin technology is an emerging minimally invasive technique for repairing white spot lesions. There is a lack of comparative study on infiltration resin technology and other methods for repairing white spot lesions.
    OBJECTIVE: To compare the aesthetic effect of infiltration resin and microabrasion in the restoration of post-orthodontic white spot lesions.
    METHODS: Twenty-two patients with 88 teeth with white spot lesions after orthodontic treatment at Baodi Clinical College of Tianjin Medical University were recruited. A simple randomized and controlled design was used to allocate patients to resin infiltration and microabrasion groups (n=11/group). The patient’s satisfaction, clinical effect, area ratio of white spot lesions and treatment efficiency were compared between two groups, immediately, 1 week and 1, 3, 6 and 12 months after treatment. The study was approved by the Ethics Committee of Baodi Clinical College of Tianjin Medical University, approval number: TJBDYY-2015-26-R1.
    RESULTS AND CONCLUSION: (1) The patient’s satisfaction in the resin infiltration group was significantly higher than that in the microabrasion group at different time points after treatment (P < 0.05). (2) Within 1 year after restoration, there were two teeth without change in the tooth white spot lesions in the infiltration resin group, and nine teeth without change in the tooth white spot lesions in the microabrasion group. The infiltration resin group had a higher success rate in aesthetic treatment of white spot lesions after orthodontics than the microabrasion group. (3) Compared with that before restoration, the area ratio of white spot lesions was decreased at different time points in both groups (P < 0.05), and the area ratio of white spot lesions in the infiltration resin group was lower than that in the microabrasion group at different time points (P < 0.05). (4) The treatment efficiency in the infiltration resin group was significantly higher than that in the microabrasion group at different time points (infiltration resin group: 71.31%, 83.95%, 85.08%, 89.65%, 89.11%, 88.90%; microabrasion group: 45.34%,   61.69%, 64.80%, 68.59%, 64.12%, 55.95%, P < 0.05). (5) Our results indicate that resin infiltration is more effective than microabrasion in the treatment of post-orthodontic white spot lesions, and the effect is stable within 12 months．
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    Short-term biosafety of novel absorbable nano-hydroxyapatite/collagen/poly(lactic acid) composite
    Gao Li, Wang Shuyan, Wang Rui, Xu Yonghua, Gao Jingjing, Zhang Li, Liu Wentao
    2019, 23 (22):  3530-3535.  doi: 10.3969/j.issn.2095-4344.1279
    Abstract ( 309 )   PDF (965KB) ( 98 )   Save
    BACKGROUND: A novel nano-hydroxyapatite/collagen/poly(lactic acid) composite was manufactured in our preliminary experiments.
    OBJECTIVE: To evaluate the biosafety of nano-hydroxyapatite/collagen/poly(lactic acid) composite.
    METHODS: Nano-hydroxyapatite/collagen/poly(lactic acid) composite was prepared into three kinds of leaching liquor containing 100, 150 and 200 g/L poly(lactic acid), namely, nHAC/PLA1, nHAC/PLA2, nHAC/PLA3. (1) Cytotoxicity test: L929 cells were cultured with nHAC/PLA1, nHAC/PLA2, nHAC/PLA3 leaching liquor and culture medium and cell toxicity was evaluated using MTT assay. (2) Acute systemic toxicity test: nHAC/PLA1, nHAC/PLA2, nHAC/PLA3 leaching liquor and normal saline were injected into C57 mice (Laboratory Animal Center of Zhengzhou University, China) via the tail vein. At 24, 48, 72 hours after injection, the general situation of mice was observed and body weight was recorded. (3) Serum toxicity test: SD rats (Laboratory Animal Center of Zhengzhou University) were intragastrically administered nHAC/PLA1, nHAC/PLA2, nHAC/PLA3 leaching liquor and normal saline. Seven days later, serum level of interleukin-1 protein was detected by enzyme-linked immunosorbent assay. (4) Skin sensitization test: 25 guinea pigs (Laboratory Animal Center of Zhengzhou University) were randomly treated with nHAC/PLA1, nHAC/PLA2, nHAC/PLA3 leaching liquor (experimental groups), normal saline (negative control group), and 5% formaldehyde (positive control group). At 24, 48 and 72 hours after intracutaneous induction, local induction, and provocation, skin sensitization reactions, including erythema and edema, were observed in each group. (5) Hemolysis test: anti-rabbit antibodies were added into the leaching liquor of test samples, saline and distilled water to determine the rate of hemolysis. The study was approved by Ethics Committee of Zhengzhou University, China.
    RESULTS AND CONCLUSION: The in vitro cytotoxicity of nano-hydroxyapatite/collagen/poly(lactic acid) composite was graded 0. Negative results were obtained in acute systemic toxicity test, serum toxicity test, skin sensitization test, acute hemolytic test, and hemolysis test of nano-hydroxyapatite/collagen/poly(lactic acid) composite. These results suggest good biosafety of nano-hydroxyapatite/ collagen/poly(lactic acid) composite.
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    Preparation, sustained release and anti-tumor characteristics of hydroxypropyl chitosan/heparin nano-drug system
    Du Jianhong, Fan Chunshui, Du Yuelian, Sun Xiaoyu, Wang Qingfeng
    2019, 23 (22):  3536-3541.  doi: 10.3969/j.issn.2095-4344.1280
    Abstract ( 21 )   PDF (1012KB) ( 60 )   Save
    BACKGROUND: When heparin drugs are used in human body, there are some clinical problems such as high toxicity and short-term metabolism.
    OBJECTIVE: To prepare hydroxypropyl chitosan/heparin nano-drug system, and to investigate its drug loading, micromorphology, particle size distribution, in vitro release and inhibitory effect on hepatocellular carcinoma cells.
    METHODS: The volume ratios of heparin solution and hydroxypropyl chitosan solution were set as 3:10, 6:10 and 9:10, and the hydroxypropyl chitosan/heparin nanoparticles were prepared by charge attraction method and to detect its property. The 24-hour release rate of the particle in PBS with pH=2.1, 4.6 and 7.4 was investigated. The SMMC-7721 cell lines were inoculated in 96-well plate. Meanwhile, heparin (2.5, 5, 10, and 20 mg/L), and hydroxypropyl chitosan/heparin nanoparticles were added. After cultured for 24 hours, the cell inhibition rate was measured.
    RESULTS AND CONCLUSION: (1) When the volume ratio of heparin solution and hydroxypropyl chitosan was 3:10, 6:10 and 9:10, the corresponding drug loads were (27.13±0.79)%, (36.39±1.12)% and (43.68±1.45)%, respectively. (2) The release rate for heparin of the nanoparticles prepared by the volume ratio of heparin solution and hydroxypropyl chitosan of 6:10 under the condition of pH=7.4 was faster than that under the condition of pH=2.1 or 4.6, which could release more than 95% heparin at 6 hours. At the same time, the release rate was proportional to the heparin load. (3) Hydroxypropyl chitosan solution showed no significant inhibition on the SMMC-7721 cell lines. With the increase of solution concentration, the inhibition of heparin on the SMMC-7721 cell lines increased significantly. In addition, the inhibitory effect of hydroxypropyl chitosan/heparin granules prepared when the volume ratio of heparin solution and hydroxypropyl chitosan was 6:10 was better than that of heparin alone. (4) These results indicate that the hydroxypropyl chitosan/heparin nano-loaded drug system with the 6:10 volume ratio of heparin solution and hydroxypropyl chitosan can achieve sustained release of pH sensitivity, and exerts significant inhibition on the tumor.
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    Study on immunogenicity of type I atelocollagen
    Zhang Ziqiang, Zhang Yihe, An Qi, Xu Rongrong, Li Huan, Wang Enbo
    2019, 23 (22):  3542-3548.  doi: 10.3969/j.issn.2095-4344.1738
    Abstract ( 29 )   PDF (914KB) ( 45 )   Save
    BACKGROUND: The immunogenicity of type I collagen mainly locates in the telopeptide of molecular chain, which can be inactivated through hydrolysis or removal in the process of collagen extraction. Type I atelocollagen decreases its immunogenicity.
    OBJECTIVE: To evaluate the immunogenicity of type I atelocollagen.
    METHODS: Type I atelocollagen was prepared by enzyme digestion, salting-out and dialysis. The purity of type I atelocollagen was identified through analyzing the dyeing limit of comassiebule. The residual DNA was detected by Quant-IT PicoGreen dsDNA Reagent and Kits described in YY/T 0606.25-2014. The effect of telopeptide removing was detected by ELISA. The content of α-Gal antigen was tested according to the criteria in YY/T 1561-2017.
    RESULTS AND CONCLUSION: The purity of type I atelocollagen reached 99.8%. The residual DNA was below 4 µg/g. The contents of N-terminal telopeptide and C-terminal telopeptide were lower than the examination limit. The content of α-Gal antigen was lower than the detection limit. The immunogenicity of collagen is remarkably decreased by preparing type I atelocollagen using enzyme digestion, salting-out and dialysis, which can effectively control its risk of immunogenicity in clinical application.
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    Protective effect of glucose-dependent incretin analogue DAIa2GIP on knee cartilage injury of rats
    Yang Xuan, Han Pengfei, Zhou Xin, Lu Jiangong, Wang Shichuan, Wang Yuze
    2019, 23 (22):  3549-3555.  doi: 10.3969/j.issn.2095-4344.1281
    Abstract ( 20 )   PDF (2251KB) ( 40 )   Save
    BACKGROUND: Glucose-dependent incretin analogue DAIa2GIP has been shown to directly regulate the growth and development of osteoblasts, but its effect on chondrocytes is rarely reported.
    OBJECTIVE: To investigate the protective effect and potential mechanism of glucose-dependent incretin analogue DAIa2GIP on cartilage injury in Sprague-Dawley rats with osteoarthritis.
    METHODS: Fifty male Sprague-Dawley rats provided by Laboratory Animal Center of Shanxi Medical University were randomly divided into five groups (n=10/group): normal control group (no intervention), model control group (anterior cruciate ligament and medial collateral ligament resection, and medial meniscus removal at bilateral posterior knees + normal saline), model treatment group (anterior cruciate ligament and medial collateral ligament resection, and medial meniscus removal at bilateral posterior knees + 25 nmol/kg DAIa2GIP) and sham control group (opening articular capsule of bilateral knees + normal saline), and sham treatment group (opening articular capsule of bilateral knees + 25 nmol/kg DAIa2GIP). The intraperitoneal administration was given at 8 weeks after modeling, twice weekly for 8 consecutive weeks. The knee joint was removed at 16 weeks after modeling for hematoxylin-eosin staining, safranin O-fast green staining, transmission electron microscope and immunohistochemistry. The study was approved by the Ethics Committee of Shanxi Medical University, approval number: 2017008.
    RESULTS AND CONCLUSION: (1) Hematoxylin-eosin staining: the four layers of the cartilage structure in the model control group were obscure. The four layers of the cartilage structure were visible in the model treatment group, and the cartilage lay was thicker than that in the model group. In the other three groups, the cartilage surface was smooth with clear four layers. (2) Safranin O-fast green staining: the expression of proteoglycan in the model control group was uneven, and cartilage thickness was thin. The expression of proteoglycan in the model treatment group was even, and the cartilage thickness was increased compared with the model control group. The expression of proteoglycan in the other three groups was even, with moderate cartilage thickness. (3) Transmission electron microscope: there were lipid droplets in the model control group, and mitochondria and rough endoplasmic reticulum disappeared. In the model treatment group, some mitochondria and rough endoplasmic reticulum were observed, and the structure returned to be normal. The other three groups showed the normal structure. (4) Immunohistochemistry: compared with the normal control group, the expression level of collagenase 13 was significantly increased (P < 0.05), and the expression level of collagen type II was significantly decreased in the model control group (P < 0.05). Compared with the model control group, the expression level of collagenase 13 was significantly decreased (P < 0.05), and the expression level of collagen type II was significantly increased in the model treatment group (P < 0.05). (5) To conclude, DAIa2GIP exerts protective effect on articular cartilage in Sprague-Dawley rats with osteoarthritis possibly by inhibiting the expression of collagenase 13 and reducing collagen type II destruction in articular cartilage.
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    Effect of collagenase type II on the biomechanical properties of rabbit cornea
    Chen Xinyan, Qin Xiao, Zhang Haixia, Li Lin
    2019, 23 (22):  3556-3561.  doi: 10.3969/j.issn.2095-4344.1282
    Abstract ( 24 )   PDF (1996KB) ( 52 )   Save
    BACKGROUND: Many pathological states of the cornea are associated with abnormal expression of collagenase type II, which can cause corneal matrix degradation and may result in the changes of corneal mechanical properties. The mechanical properties of the cornea are closely related to the corneal shape and refractive state.
    OBJECTIVE: To observe the changes in the mechanical properties of the rabbit cornea after treatment with collagenase type II.
    METHODS: After anesthesia and epithelial debridement, a collagenase type II solution (18 g/L, 200 μL) was used to treat the left eyes of the experimental rabbits for 30 minutes. Then all rabbits were normally raised for 3 months. The experiments were approved by the Ethics Committee of Animal Experiment and Laboratory Animal Welfare of Capital Medical University (approval No. AEEI-2014-066).  
    RESULTS AND CONCLUSION: Compared with the control eyes, the elastic modulus of the experimental eyes in the low and high strain regions decreased by 51.5% and 29.9%, respectively. Overall, the degree of stress relaxation of the experimental eyes was smaller than that of the control eyes. These results suggest that collagenase type II eads to changes in corneal mechanical properties, decreases in elastic modulus, decreases in the degree of overall stress relaxation, and decreases in the overall carrying capacity of the cornea.  
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    Valve replacement or valve ring implantation and Cox-Maze III procedure for older adults with mitral valve disease complicated by persistent or long-standing persistent atrial fibrillation
    Han Bing, Wang Huishan, Han Jinsong, Yin Zongtao, Xie Saiqi
    2019, 23 (22):  3562-3569.  doi: 10.3969/j.issn.2095-4344.1753
    Abstract ( 15 )   PDF (2614KB) ( 64 )   Save
    BACKGROUND: Preliminary studies have shown that the Cox-Maze III procedure is safe and effective method to treat persistent or long-standing persistent atrial fibrillation. As the surgical tolerance of elderly patients is poor, the safety and effectiveness of Cox-Maze III for elderly patients are rarely reported.
    OBJECTIVE: To evaluate the safety and efficacy of Cox-Maze III procedure in elderly patients with mitral valve disease complicated by persistent or long-standing persistent atrial fibrillation.
    METHODS: One hundred and sixty-six patients with mitral valve disease complicated by persistent or long-standing persistent atrial fibrillation admitted at General Hospital of Northern Theater Command (General Hospital of Shenyang Military Region of Chinese PLA) from May 2013 to November 2017 were included. According to the World Health Organization definition of the elderly people, they were divided into elder group (≥ 60 years, n=70) and young group (< 60 years, n=96), followed by undergoing Cox-Maze III procedure and valvular replacement or valvuloplasty. The intraoperative indexes, postoperative safety indexes and early-term and efficacy were compared between two groups. The study was approved by the Ethics Committee of General Hospital of Northern Theater Command (General Hospital of Shenyang Military Region of Chinese PLA), approval number: k(2015)33.
    RESULTS AND CONCLUSION: (1) Intraoperative safety indexes: there was no significant difference in the time of aortic clamping, cardiopulmonary bypass time, blood loss and surgical type between two groups (P > 0.05). The elderly group had more patients to conduct the coronary artery bypass grafting and the use of biological valve than the young group (P < 0.05). (2) Postoperative safety indexes: the incidence of adverse events such as the re-thoratomy for hemaostsis, low cardiac output syndrome, stroke, hepatic and renal dysfunction, secondary tracheal intubation, intra-aortic balloon pump implantation, temporary pacemaker application and early-term mortality were insignificant differences between two groups (P > 0.05). There were no significant differences in the intensive care unit stay time and postoperative hospitalization time (P > 0.05) between two groups. The time of ventilator use in the elderly group was significantly longer than that in the young group (P < 0.05). (3) Postoperative efficacy: the New York Heart Association classes at discharge and postoperative 6 and 12 months were significantly improved in all patients compared with the baseline, and there was no significant difference between two groups (P > 0.05). The rate to achieve sinus rhythm at discharge and postoperative 6 and 12 months showed no significant difference between two groups (P > 0.05), which reached above 85%. (4) These results indicate that Cox-Maze III procedure possesses safety for elderly patients with mitral valve disease complicated by persistent or long-standing persistent atrial fibrillation, and the short-term efficacy is satisfactory.
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    Regulatory role of Sox9 in metabolism of articular cartilage extracellular matrix
    Fang Peng, Zhao Jianning, Zhang Lei
    2019, 23 (22):  3570-3576.  doi: 10.3969/j.issn.2095-4344.1283
    Abstract ( 14 )   PDF (754KB) ( 40 )   Save
    BACKGROUND: Extracellular matrix of chondrocytes plays a role in joint degeneration. Sox9 is an important transcription factor in cells, and plays an important regulatory role in the metabolism of articular cartilage extracellular matrix. It can promote the gene transcription of cartilage markers: type II collagen, proteoglycan and type IX collagen, and inhibit the expression of aggrecanase and matrix metalloproteinase, thereby maintaining the chondrocyte phenotype. Sox9 is up-regulated in compensatory expression in the early stage of osteoarthritis, and down-regulated as the disease progresses. Therefore, Sox9 is an important target for the progressive development of osteoarthritis.

    OBJECTIVE: To review the role of Sox9 in the metabolism of chondrocyte extracellular matrix.

    METHODS: A computer-based search was performed in the PubMed and CNKI databases for articles addressing Sox9. The keywords were “Sox9, osteoarthritis, collagen type II, collagen type X, MMPs, ADAMTS” in English and Chinese, respectively. Finally, 65 eligible articles were included to review.

    RESULTS AND CONCLUSION: (1) Sox9 is the main regulatory factor of chondrocytes and one of the key transcription factors to maintain chondrocyte phenotype and cartilage homeostasis. (2) However, the specific mechanism for the regulation of Sox9 gene expression is very complex at present. How to up-regulate the expression of Sox9 gene in chondrocytes is expected to become an important direction for the prevention and treatment of osteoarthritis
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    Application and hotspot of irrigation solution in open fracture debridement
    Jiang Shengyuan, Zhang Kai
    2019, 23 (22):  3577-3583.  doi: 10.3969/j.issn.2095-4344.1285
    Abstract ( 14 )   PDF (797KB) ( 27 )   Save
    BACKGROUND: Debridement is the key to open fracture treatment, and the irrigation of the wound is an important step. There are some controversies about the selection of irrigation solution in debridement, and the corresponding animal experiments and clinical studies have become the focus of research in recent years.
    OBJECTIVE: To review the latest research progress of the selection of irrigation solution for open fractures debridement.
    METHODS: A computer-based online search of PubMed and CNKI databases was performed for the articles published from January 1959 to May 2018. The keywords were “open fracture, debridement, irrigation solution” in English and Chinese, respectively. Finally 44 eligible articles were included to review.
    RESULTS AND CONCLUSION: (1) After a large number of animal experiments and clinical application, open fracture debridement, prevention of infection, irrigation solution and evaluation of prognosis have been deeply studied, especially the study of the type of irrigation solution in debridement. (2) Traditional sterile saline is still the most convenient and effective choice, antiseptics, surfactants, antibiotics and other additives have also become the research focus in recent years.
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    Advantages and application prospects of microfluidic chip technology in cell adhesion research
    Zhuan Hang, Zheng Guoxia, Wang Yunhua
    2019, 23 (22):  3584-3590.  doi: 10.3969/j.issn.2095-4344.1302
    Abstract ( 11 )   PDF (969KB) ( 31 )   Save
    BACKGROUND: Cell adhesion affects cell migration, proliferation, and differentiation. It is of extremely vital significance for cell separation and enrichment, tissue engineering and clinical disease research. Microfluidic chips have unique advantages in cell adhesion studies such as miniaturization, integration, high throughput, low energy consumption, and rapid analysis.
    OBJECTIVE: To summarize and discuss the latest advances of microfluidic chip technology in cell adhesion research.
    METHODS: The first author performed a data retrieval of PubMed and Bailianyun databases to search the articles published during 2008-2018 and addressing cell adhesion and microfluidic chip technology and reviewed the literatures systematically.
    RESULTS AND CONCLUSION: A total of 238 articles were retrieved and 53 articles were included in the final analysis according to the inclusion and exclusion criteria. These articles were read, summarized and analyzed. Results showed that the microfluidic chip platform provides new possibilities for in vitro studies of cell adhesion because it exhibits higher throughput, enables precise control of the biological, physical, and chemical factors involved in the construction of in vivo cellular microenvironment, and regulates a series of cellular behaviors including cell adhesion, migration, growth, proliferation, differentiation, cell-cell interactions, and cell-matrix interactions. Microfluidic chip technology has broad application prospects in the dynamic monitoring of cell adhesion process, quantitative measurement of cell adhesion, isolation and enrichment of rare cells, screening of biomedical materials, and research on cell adhesion-related diseases.
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    Meta-analysis of clinical efficacy of soft silicone dressing for treating radiation-induced skin reaction
    Shi Xueping, Lei Youjin, Zeng Zhumei, Luo Jianghe, Huang Ruina, Yang Ming
    2019, 23 (22):  3591-3598.  doi: 10.3969/j.issn.2095-4344.1741
    Abstract ( 452 )   PDF (1269KB) ( 85 )   Save
    BACKGROUND: Soft silicone dressing has been reported to improve the skin situation for patients suffering from radiotherapy, but these studies are small-sample trials. Therefore, it is necessary to evaluate the studies at home and abroad addressing that soft silicone dressing applied in the patients undergoing radiotherapy by meta-analysis.
    OBJECTIVE: To investigate the differences in the effectiveness of soft silicone dressing and conventional nursing in the prevention and treatment of radiation-induced skin reaction.
    METHODS: Databases of CNKI, CBM, WanFang, PubMed, and Cochrane Library were searched to retrieve the randomized clinical trials or non-randomized clinical trials concerning the effects of soft silicone dressing and conventional nursing in radiation-induced skin reaction. Meta-analysis was conducted using RevMan 5.3 software.
    RESULTS AND CONCLUSION: Eleven studies were enrolled, involving 1 284 patients. The patients received the soft silicone dressing (trial group) and conventional nursing (control group) to treat and prevent radiation-induced skin reaction. Meta-analysis revealed that compared with the control group, in the trial group, there was an decrease the incidence of moist desquamation [OR=0.13, 95%CI (0.09, 0.19, P < 0.05], grade II, III and IV [OR=0.30, 95%CI (0.21, 0.44), P < 0.05; OR=0.14, 95%CI (0.07, 0.28), P < 0.05; OR=0.06, 95%CI (0.01, 0.47), P < 0.05], combined RISRAS score was decreased [OR=-1.12, 95%CI (-2.21, -0.04, P < 0,05], pain degree was alleviated [MD=-1.44, 95%CI (-1.93, -0.95), P < 0.05], incidence of painless was increased [OR=4.83, 95%CI (2.93, 7.99), P < 0.05], and the wound healing time was shortened [OR=-6.03, 95%CI (-7.47, -4.59, P < 0.05]. These results indicate that soft silicone dressing can relieve the severity of radiation-induced skin reaction and pain, and accelerate wound healing compared with the conventional nursing, which is a rational and effective method in the prevention and treatment of radiation-induced skin reaction.
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    Application of foam dressing in tracheotomy: a meta-analysis
    Qiu Wenbo, Wu Xiaowan, Han Hui, Huang Ruina, Chen Huichao
    2019, 23 (22):  3599-3603.  doi: 10.3969/j.issn.2095-4344.1740
    Abstract ( 24 )   PDF (827KB) ( 40 )   Save
    BACKGROUND: Foam dressing has been shown to reduce the risk of complications of tracheal incision, reduce the frequency of dressing change and shorten the healing time.
    OBJECTIVE: To evaluate the effect of foam dressing in patients undergoing tracheotomy by meta-analysis.
    METHODS: A computer-based search of randomized controlled trials concerning foam dressing applied in tracheotomy was carried out in PubMed, EMBASE, Cochrane, CNKI, CBM, WanFang and VIP databases before May 2018. Literature screening, quality evaluation and data extraction were conducted independently by two postgraduates. Revman 5.3 software was used for data analysis.
    RESULTS AND CONCLUSION: Eighteen randomized controlled trials were included. The patients in the trial group were treated with foam dressing at the trachea incision, while the control group was treated with sterile gauze at the trachea incision. Meta-analysis results showed that the incidence of tracheal incision complications in the trial group was lower than that in the control group [OR=0.18, 95%CI (0.11, 0.27), Z=7.82, P < 0.000 01], the interval of dressing change was longer than that in the control group [OR =4.94, 95%CI (3.70, 6.18), Z=7.81, P < 0.000 01], and the healing time of tracheal incision was shorter than that in the control group [OR=-1.39, 95%CI (-1.64, -1.15), Z=11.30, P < 0.000 01]. To conclude, the effect of foam dressing is better than that of sterile gauze in patients undergoing tracheotomy.
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    Percutaneous vertebroplasty by bone cement perfusion using the unilateral transverse process-pedicle approach for treatment of thoracolumbar osteoporotic vertebral compression fracture
    He Jiangtao, Wang Sanmu, Li Zhongyi
    2019, 23 (22):  3604-3608.  doi: 10.3969/j.issn.2095-4344.1327
    Abstract ( 24 )   PDF (931KB) ( 30 )   Save
    BACKGROUND: During vertebroplasty for treatment of osteoporotic vertebral compression fracture, traditional pedicle puncture route easily punctures the medial wall of the pedicle and causes spinal cord injury.
    OBJECTIVE: To investigate the clinical effect of percutaneous vertebroplasty by bone cement perfusion via using the unilateral transverse process-pedicle approach in the treatment of thoracolumbar osteoporotic vertebral compression fracture.
    METHODS: Thirty patients (42 vertebral bodies) with osteoporotic vertebral compression fracture who received treatment during November 2016 to March 2017 in the Fifth Affiliated Hospital of Zhengzhou University, China were included in this study. These patients consisted of 9 males and 21 females, aged 58-82 years. All of them underwent percutaneous vertebroplasty by bone cement perfusion via unilateral transverse process-pedicle approach. Bone cement leakage was recorded. Before treatment, 1 week after treatment and at the last follow-up, imaging was used to observe the recovery of vertebral height and changes of Cobb angle, to measure Visual Analogue Score, which was used to evaluate the pain, and Oswestry Disability Index score, which was used to evaluate the improvement of daily activity function. This study was approved by the Ethics Committee of The Fifth Affiliated Hospital of Zhengzhou University.
    RESULTS AND CONCLUSION: All 30 patients successfully completed the operation and were followed up for 6-9 months. Among the 42 vertebral bodies, bone cement leaked to the intervertebral space in 4 vertebral bodies and it leaked to the anterior edge of the vertebral body in 2 vertebral bodies. There was no leakage in the spinal canal, and the total leakage rate was 14%. No adverse clinical symptoms were observed. In 30 patients, Visual Analogue Scores and Oswestry Disability Index scores at 1 week after treatment and at the last follow-up were significantly lower than those before treatment (P < 0.05). In 30 patients, at 1 week after treatment and the last follow-up, the vertebral body height of the patients was significantly higher (P < 0.05), as well as the Cobb angle was significantly lower (P < 0.05), compared with before treatment (P < 0.05). The results suggest that percutaneous vertebroplasty by bone cement perfusion via unilateral transverse process-pedicle approach is a safe and effective method for the treatment of thoracolumbar osteoporotic vertebral compression fracture.
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