Single-Row or Double-Row Fixation Technique for Full-Thickness Rotator Cuff Tears: A Meta-Analysis

Background

The single-row and double-row fixation techniques have been widely used for rotator cuff tears. However, whether the double-row technique produces superior clinical or anatomic outcomes is still considered controversial. This study aims to use meta-analysis to compare the clinical and anatomical outcomes between the two techniques.

Methods

The Pubmed, Embase, and Cochrane library databases were searched for relevant studies published before November 1, 2012. Studies clearly reporting a comparison of the single-row and double-row techniques were selected. The Constant, ASES, and UCLA scale systems and the rotator cuff integrity rate were evaluated. The weighted mean differences and relative risks were calculated using a fixed-effects or random-effects model.

Results

Eight studies were included in this meta-analysis. The weighted mean differences of the ASES (−0.84; P = 0.04; I² = 0%) and UCLA (−0.75; P = 0.007; I² = 0%) scales were significantly low in the single-row group for full-thickness rotator cuff tears. For tear sizes smaller than 3 cm, no significant difference was found between the groups no matter in Constant (P = 0.95; I² = 0%), ASES (P = 0.77; I² = 0%), or UCLA (P = 0.24; I² = 13%) scales. For tear sizes larger than 3 cm, the ASES (−1.95; P = 0.001; I² = 49%) and UCLA (−1.17; P = 0.006; I² = 0%) scales were markedly lower in the single-row group. The integrity of the rotator cuff (0.81; P = 0.0004; I² = 10%) was greater and the partial thickness retear rate (1.93; P = 0.007; I² = 10%) was less in the double-row group. Full-thickness retears showed no difference between the groups (P = 0.15; I² = 0%).

Conclusion

The meta-analysis suggests that the double-row fixation technique increases post-operative rotator cuff integrity and improves the clinical outcomes, especially for full-thickness rotator cuff tears larger than 3 cm. For tear sizes smaller than 3 cm, there was no difference in the clinical outcomes between the two techniques.

Level of Evidence

Level I.     

All-Arthroscopic versus Mini-Open Repair of Small to Large Sized Rotator Cuff Tears: A Meta-Analysis of Clinical Outcomes

Purpose

The purpose of this study was to compare clinical outcomes of patients with full-thickness small to large sized tears undergoing all-arthroscopic versus mini-open rotator cuff repair.

Method

A literature search for electronic databases and references for eligible studies was conducted through Medline, Embase and Cochrane library between 1969 and 2013.

Results

A total of 12 comparative studies (n = 770 patients) were included. Pooled results showed: there were no differences in function outcome, pain scores, retear rate or the incidence of adhesive capsulitis between all arthroscopic and mini-open repair groups.

Conclusions

There were no differences in outcomes between the arthroscopic and mini-open rotator cuff repair techniques, they should be considered alternative treatment options.

Level of Evidence

Level IV, Meta analysis.     

A Canine Non-Weight-Bearing Model with Radial Neurectomy for Rotator Cuff Repair

Background

The major concern of using a large animal model to study rotator cuff repair is the high rate of repair retears. The purpose of this study was to test a non-weight-bearing (NWB) canine model for rotator cuff repair research.

Methods

First, in the in vitro study, 18 shoulders were randomized to 3 groups. 1) Full-width transections repaired with modified Mason-Allen sutures using 3-0 polyglactin suture, 2) Group 1 repaired using number 2 (#2) polyester braid and long-chain polyethylene suture, and 3) Partial-width transections leaving the superior 2 mm infraspinatus tendon intact without repair. In the in vivo study of 6 dogs, the infraspinatus tendon was partially transected as the same as the in vitro group 3. A radial neurectomy was performed to prevent weight bearing. The operated limb was slung in a custom-made jacket for 6 weeks.

Results

In the in vitro study, mean ultimate tensile load and stiffness in Group 2 were significantly higher than Group 1 and 3 (p<0.05). In the in vivo study, gross inspection and histology showed that the preserved superior 2-mm portion of the infraspinatus tendon remained intact with normal structure.

Conclusions

Based on the biomechanical and histological findings, this canine NWB model may be an appropriate and useful model for studies of rotator cuff repair.     

肩关节镜下单排缝合技术治疗不同程度肩袖损伤的效果评估

目的:评估肩关节镜下单排缝合技术治疗不同程度肩袖损伤的效果。方法:选取2012年02月-2014年05月40例行肩关节镜下肩袖修补术患者,根据Gerber分型,其中中、小型肩袖损伤20例为一组(以下简称A组),大的、巨大肩袖损伤20例为一组(以下简称B组)。其中A组男12例,女8例,年龄37-77岁(平均年龄51岁),右侧15例,左侧5例;B组男10例,女10例,年龄40-78岁(平均年龄57岁),右侧18例,左侧2例。两组手术均采用金属缝合锚单排缝合技术进行肩袖修补,并采用ASES、Constant-Murley以及UCLA肩关节功能评分标准进行术前术后功能评估。结果:两组患者术后均获得随访,随访时间6-31个月(平均17.3个月)。通过术后肩关节活动度、三种肩关节功能评分与术前相比,差异有统计学意义(P0.05)。A组各项评分优良率占为95%,B组优良率占85%。术后患者两组肩关节肿痛症状均明显好转,运动及生活功能恢复正常,肩关节活动度明显改善。A组较B组相比,有比较好的手术预期效果,且各项评分结果差异有统计学意义(P0.05)。结论:缝合锚固件具有良好的相容性和适应性,固定可靠,具有高强度的优点,以获得稳定的早期固定。对于不同程度肩袖损伤,肩关节镜下单排缝合技术具有创伤小、恢复快、效果好等优势,配合重建后功能锻炼,肩关节功能能够恢复到令人满意的水平,但中小型肩袖撕裂的术后效果比较大的、巨大的肩袖撕裂好。     

关节镜下同期行冻结肩松解术对肩袖损伤患者的治疗效果评估

目的:评估关节镜下同期行冻结肩松解术对肩袖损伤患者的治疗效果。方法:选择2015年3月到2018年3月在我院诊治的肩袖损伤患者70例进行研究,按随机数表法将其分为观察组(n=36)和对照组(n=34)。对照组采用传统小切口肩袖修复术治疗,观察组采用关节镜下同期行冻结肩松解术进行治疗。比较两组治疗后疗效、手术时间、术中出血量、住院时间、疼痛减轻时间、治疗前后VAS、美国肩肘外科协会评分(ASES)、Contant-Muley评分的变化情况。结果:治疗后,观察组总有效率为94.44%,显著高于对照组(73.53%,P0.05);观察组手术时间、术中出血量、住院时间及疼痛减轻时间均显著低于对照组(P0.05);两组VAS、ASES、Contant-Muley评分较治疗前均显著改善(P0.05),且观察组VAS评分明显低于对照组,ASES及Contant-Muley评分显著高于对照组(P0.05)。结论:关节镜下同期行冻结肩松解术治疗肩袖损伤的临床疗效显著优于传统小切口肩袖修复术治疗,其可显著促进关节功能恢复,并减轻患者痛苦。     

Florid Suprascapular Neuropathy after Primary Rotator Cuff Repair Attributed to Suprascapular Notch Constriction in the Setting of Double Crush Syndrome

This report describes a patient who had an open repair of a small supraspinatus tendon tear performed 6 months after an arthroscopic acromioplasty with debridement had failed to provide pain relief. Three months prior to the tendon repair, he had a two-level cervical spine discectomy and fusion (C4–5, C5–6) that improved his neck pain. Florid suprascapular neuropathy was detected 10 weeks after the open rotator cuff repair. Evidence of some nerve recovery resulted in a long period of observation. But unsatisfactory improvement warranted decompression of the suprascapular notch, which was found to be very stenotic. At surgery, there was no evidence of neuroma, cyst, or other compressing lesion or tissue. Therefore, it was ultimately hypothesized that there was an exacerbation of a preexisting, but clinically unrecognized, entrapment of the suprascapular nerve in the suprascapular notch in the setting of cervical radiculopathy (primarily C5). Retrospectively it was also concluded that had this compressive etiology been recognized, it would have favored prompt decompression rather than the long observation period. Three years was required to achieve a good result following suprascapular notch decompression. The underlying C5 radiculopathy may have created a “double crush syndrome” that contributed to the propensity for injury and the prolonged recovery. There should be heightened awareness of this problem in patients who do not have satisfactory improvement in shoulder pain from previous shoulder and neck surgery.     

肩袖间隙影像解剖及常见病变的研究进展

肩袖间隙在解剖学上是肩关节的一个复合区域,在维持肩关节稳定性和保护肱二头肌长头肌腱功能起重要作用。对肩袖间隙解剖结构及功能的深入认识有助于肩袖间隙损伤性病变、挛缩性病变等的及时诊断和合理治疗。影像学检查尤其是磁共振逐步成为肩袖间隙疾病最主要的检查方法,包括常规扫描、直接及间接性磁共振肩关节造影、增强扫描等。本文将就肩袖间隙的影像解剖及常见病变的相关研究进行综述。     

Effect of Bone Mineral Density on Rotator Cuff Tear: An Osteoporotic Rabbit Model

IntroductionAn increased bone mineral density (BMD) in the proximity to tendon insertion can improve rotator cuff repair and healing. However, how a decrease of BMD in the humeral head affects the biomechanical properties of the rotator cuff tendon is still unclear. Previous studies have demonstrated ovariectomy in animals to lead to osteoporosis and decreased BMD, and Teriparatide (PTH) administration to improve BMD and strength of bone. This study aimed to explore the correlation between humeral head BMD and infraspinatus (ISP) tendon insertion strength, and if an increase in bone quantity of the humeral head can improve the strength of the rotator cuff.ResultsSignificant differences were observed in the measured humeral head BMD of the Control and OVX-PTH groups compared to the OVX-Saline group (P = 0.0004 and P = 0.0024, respectively). No significant difference was found in failure stress among the three groups, but an expected trend with the control group and OVX-PTH group presenting higher failure strength compared to the OVX-Saline group. BMD at the humeral head showed a positive linear correlation with stress (r² = 0.54). Histology results showed the superiority in OVX-PTH group ISP enthesis compared to the OVX-Saline group.ConclusionBone loss of the humeral head leads to decreased tendon/bone insertion strength of the infraspinatus tendon enthesis. Teriparatide administration can increase bone density of the humeral head and may improve the mechanical properties of the infraspinatus tendon enthesis.     

Quantitative Analysis of the Deltoid and Rotator Cuff Muscles in Humans and Great Apes

The shoulder is one of the anatomic regions differentiating orthograde primates (gibbons, orangutans, gorillas, chimpanzees, bonobos, and humans) from the rest of the pronograde primates. Orthograde primates are characterized by a dorsal position of the scapula and a more lateral orientation of the glenoid cavity. This anatomic pattern, together with adaptations in related osteological structures and muscles, serves to facilitate the elevation of the upper extremity in the scapular plane. We quantified the proportions of the muscles comprising the principal functional and stabilizing components of the glenohumeral joint —deltoid, subscapularis, supraspinatus, infraspinatus, and teres minor— in 3 species of orthograde primates: Pongo pygmaeus, Pan troglodytes, and Homo sapiens. Our objective was to determine whether quantifiable differences in these muscles relate to the functional requirements of the types of locomotion used by these 3 species: suspension/vertical climbing, knuckle-walking, and bipedalism. We observed a close similarity between the proportional mass of these muscles in Homo sapiens and Pongo pygmaeus, whereas Pan troglodytes displayed a unique anatomic pattern, particularly in the subscapularis, which may be due to differences in how the glenohumeral joint is stabilized in a great ape knuckle-walker. Our findings may help explain the high incidence of subacromial impingement syndrome in humans.     

Proteomics Perspectives in Rotator Cuff Research: A Systematic Review of Gene Expression and Protein Composition in Human Tendinopathy

Background

Rotator cuff tendinopathy including tears is a cause of significant morbidity. The molecular pathogenesis of the disorder is largely unknown. This review aimed to present an overview of the literature on gene expression and protein composition in human rotator cuff tendinopathy and other tendinopathies, and to evaluate perspectives of proteomics – the comprehensive study of protein composition - in tendon research.

Materials and Methods

We conducted a systematic search of the literature published between 1 January 1990 and 18 December 2012 in PubMed, Embase, and Web of Science. We included studies on objectively quantified differential gene expression and/or protein composition in human rotator cuff tendinopathy and other tendinopathies as compared to control tissue.

Results

We identified 2199 studies, of which 54 were included; 25 studies focussed on rotator cuff or biceps tendinopathy. Most of the included studies quantified prespecified mRNA molecules and proteins using polymerase chain reactions and immunoassays, respectively. There was a tendency towards an increase of collagen I (11 of 15 studies) and III (13 of 14), metalloproteinase (MMP)-1 (6 of 12), -9 (7 of 7), -13 (4 of 7), tissue inhibitor of metalloproteinase (TIMP)-1 (4 of 7), and vascular endothelial growth factor (4 of 7), and a decrease in MMP-3 (10 of 12). Fourteen proteomics studies of tendon tissues/cells failed inclusion, mostly because they were conducted in animals or in vitro.

Conclusions

Based on methods, which only allowed simultaneous quantification of a limited number of prespecified mRNA molecules or proteins, several proteins appeared to be differentially expressed/represented in rotator cuff tendinopathy and other tendinopathies. No proteomics studies fulfilled our inclusion criteria, although proteomics technologies may be a way to identify protein profiles (including non-prespecified proteins) that characterise specific tendon disorders or stages of tendinopathy. Thus, our results suggested an untapped potential for proteomics in tendon research.     

关节镜下双排缝合桥固定与单排固定治疗肩袖全层撕裂的疗效对比及术后早期再撕裂的危险因素分析

摘要 目的：对比关节镜下双排缝合桥固定和单排固定治疗肩袖全层撕裂的疗效,并分析术后早期再撕裂的危险因素。方法：回顾性分析广州中医药大学附属北碚中医院2018年1月~2021年12月期间收治的200例肩袖全层撕裂患者的临床资料,根据手术方案的不同分为A组（n=97,接受单排固定治疗）和B组（n=103,接受双排缝合桥固定治疗）。对比两组的疼痛、肩关节功能情况、肩关节活动度及术后早期再撕裂发生率。采用单因素和多因素Logistic回归分析肩袖全层撕裂患者术后早期再撕裂的危险因素。结果：术后6个月,B组视觉疼痛模拟评分量表（VAS）评分低于A组,美国加州大学肩关节评分系统（UCLA）评分、美国肩肘外科医师学会（ASES）评分高于A组（P<0.05）。术后6个月,B组前屈、外展、体侧外旋角度大于A组（P<0.05）。B组的术后早期再撕裂总发生率低于A组（P<0.05）。术后早期再撕裂的发生与糖尿病史、撕裂大小、吸烟史、年龄、术前肌肉质量、性别、脂肪浸润、注射皮质类固醇有关（P<0.05）。多因素Logistic回归分析结果显示：年龄≥60岁、性别为男性、吸烟史、糖尿病史、撕裂大小为巨大型再撕裂、脂肪浸润、注射皮质类固醇是术后早期再撕裂发生的危险因素（P<0.05）。结论：关节镜下双排缝合桥固定治疗肩袖全层撕裂,可更好的减轻疼痛症状,改善关节功能和关节活动度。此外,糖尿病史、脂肪浸润、吸烟史、高龄、撕裂大小为巨大型再撕裂、男性、注射皮质类固醇等是肩袖全层撕裂患者术后早期再撕裂的危险因素。     

富血小板纤维蛋白膜片修复上颌窦瘘的临床研究

目的:观察自体富血小板纤维蛋白(Platelet-rich fibrin,PRF)膜片修补口腔上颌窦瘘的临床疗效。方法:选取解放军第425医院疗养区眼耳鼻喉科2010年4月到2013年4月间24例上颌窦瘘患者,采用随机分组,其中A组12例患者各采静脉血20 mL制备PRF膜片修补上颌窦瘘,另外B组12例患者采用组织瓣法修补上颌窦瘘,比较两组患者的伤口一期愈合成功率以及6-12月后随访预后并进行统计学分析。结果:PRF膜片修补组手术均获得成功,而组织瓣修补组中采用带蒂颚粘膜瓣有1例失败,两组间一期愈合成功率无显著差异(P=0.755),随访发现颊侧黏骨膜瓣修补的患者术后口腔前庭沟均有不同程度变浅,而其它修补方法术后前庭沟无明显异常。结论:自体PRF膜片制备简单,用其修补上颌窦瘘效果确切,手术简单,并发症少,可应用于临床实践。     

Impact of Bacterial Vaginosis on Perineal Tears during Delivery: A Prospective Cohort Study

Objective

Long term effects of perineal tears pose a major worldwide health issue for women during delivery. Since bacterial vaginosis is related to major obstacles in obstetrics the aim of this study was to determine the relationship between bacterial vaginosis and the occurrence of perineal tears during vaginal delivery.

Methods

Between June 2013 and December 2013 pregnant women delivering after 37 weeks were recruited at one University hospital / tertiary care referral center in the course of this single-center, prospective cohort study. Bacterial vaginosis was assessed according to Nugent score method. Logistic-regression model was used to estimate odds ratios, adjusted for other risk factors to test the relationship between bacterial vaginosis and the occurrence of 1st to 4th degree perineal tears in women undergoing vaginal delivery.

Results

A total of 728 woman were included, 662 analyzed with a complete Nugent Score of the vaginal swab. The prevalence of 1st to 4th degree perineal tears was 35.8% (95% Confidence Interval (95%CI) = [32.2; 39.6]). The presence of BV was not significantly associated to the incidence of perineal tears neither in the univariate analysis (crude Odds Ratio = 1.43; 95%CI = [0.79; 2.60]; p = 0.235) nor in the multivariate analysis (adjusted Odds Ratio = 1.65; 95%CI = [0.81; 3.36]; p = 0.167). Instrumental delivery was the most important risk factor for perineal lacerations.

Conclusions

There is no evidence that vaginosis is a risk factor for vaginal tears.

Trial Registration

ClinicalTrials.gov N° NCT01822782     

Emergent Endovascular vs. Open Surgery Repair for Ruptured Abdominal Aortic Aneurysms: A Meta-Analysis

Objectives

To systematically review studies comparing peri-operative mortality and length of hospital stay in patients with ruptured abdominal aortic aneurysms (rAAAs) who underwent endovascular aneurysm repair (EVAR) to patients who underwent open surgical repair (OSR).

Methods

The Medline, Cochrane, EMBASE, and Google Scholar databases were searched until Apr 30, 2013 using keywords such as abdominal aortic aneurysm, emergent, emergency, rupture, leaking, acute, endovascular, stent, graft, and endoscopic. The primary outcome was peri-operative mortality and the secondary outcome was length of hospital stay.

Results

A total of 18 studies (2 randomized controlled trials, 5 prospective studies, and 11 retrospective studies) with a total of 135,734 rAAA patients were included. rAAA patients who underwent EVAR had significantly lower peri-operative mortality compared to those who underwent OSR (overall OR = 0.62, 95% CI = 0.58 to 0.67, P<0.001). rAAA patients with EVAR also had a significantly shorter mean length of hospital stay compared to those with OSR (difference in mean length of stay ranged from −2.00 to −19.10 days, with the overall estimate being −5.25 days (95% CI = −9.23 to −1.26, P = 0.010). There was no publication bias and sensitivity analysis showed good reliability.

Conclusions

EVAR confers significant benefits in terms of peri-operative mortality and length of hospital stay. There is a need for more randomized controlled trials to compare outcomes of EVAR and OSR for rAAA.     

关节镜下半月板部分切除术与理疗治疗不稳定半月板撕裂的前瞻性对照研究

目的：评估针对不稳定半月板撕裂,关节镜下半月板部分切除术（APM）是否优于单纯理疗。方法：纳入36 例经磁共振确诊 为不稳定半月板撕裂的患者,平均年龄35 岁,其中9 例伴轻度骨关节炎。所有患者于前8 周,每周行3 次物理治疗,包括股四头 肌功能锻炼和神经-肌肉功能锻炼。完成康复训练后1 周行关节镜下半月板部分切除术。在治疗前、理疗结束后以及术后第4 周 随访时行VAS 评分进行疼痛评估并行Lysholm 评分进行功能评估。结果：36 例患者的VAS 评分由治疗前的5.66± 1.10,改善为 理疗结束后的4.39± 0.95（P＜0.05）,行APM 术后则达到1.82± 0.77（P＜0.05）,并且理疗对VAS 的改善不如APM 明显（P＜ 0.05）。治疗前,伴骨关节炎患者的疼痛症状更为明显,而APM 术后则与不伴骨关节炎的患者无明显差异（P＞0.05）。患者 Lysholm 评分理疗结束后由58.11± 8.06 提高到62.11± 8.34（P＜0.05）,APM术后则达到86.78± 5.50（P＜0.05）。相对于骨关节炎 患者,不伴骨关节炎患者的Lysholm 评分更高（P＜0.05）。结论：物理治疗能有效减轻疼痛和肿胀症状,但是对关节活动受限等改 善不明显。APM相对于理疗能有效缓解症状,改善膝关节功能。     

Restoration Enhances Wetland Biodiversity and Ecosystem Service Supply,but Results Are Context-Dependent: A Meta-Analysis

Wetlands are valuable ecosystems because they harbor a huge biodiversity and provide key services to societies. When natural or human factors degrade wetlands, ecological restoration is often carried out to recover biodiversity and ecosystem services (ES). Although such restorations are routinely performed, we lack systematic, evidence-based assessments of their effectiveness on the recovery of biodiversity and ES. Here we performed a meta-analysis of 70 experimental studies in order to assess the effectiveness of ecological restoration and identify what factors affect it. We compared selected ecosystem performance variables between degraded and restored wetlands and between restored and natural wetlands using response ratios and random-effects categorical modeling. We assessed how context factors such as ecosystem type, main agent of degradation, restoration action, experimental design, and restoration age influenced post-restoration biodiversity and ES. Biodiversity showed excellent recovery, though the precise recovery depended strongly on the type of organisms involved. Restored wetlands showed 36% higher levels of provisioning, regulating and supporting ES than did degraded wetlands. In fact, wetlands showed levels of provisioning and cultural ES similar to those of natural wetlands; however, their levels of supporting and regulating ES were, respectively, 16% and 22% lower than in natural wetlands. Recovery of biodiversity and of ES were positively correlated, indicating a win-win restoration outcome. The extent to which restoration increased biodiversity and ES in degraded wetlands depended primarily on the main agent of degradation, restoration actions, experimental design, and ecosystem type. In contrast, the choice of specific restoration actions alone explained most differences between restored and natural wetlands. These results highlight the importance of comprehensive, multi-factorial assessment to determine the ecological status of degraded, restored and natural wetlands and thereby evaluate the effectiveness of ecological restorations. Future research on wetland restoration should also seek to identify which restoration actions work best for specific habitats.     

Plasma Components and Platelet Activation Are Essential for the Antimicrobial Properties of Autologous Platelet-Rich Plasma: An In Vitro Study

Autologous platelet concentrates are successfully adopted in a variety of medical fields to stimulate bone and soft tissue regeneration. The rationale for their use consists in the delivery of a wide range of platelet-derived bioactive molecules that promotes wound healing. In addition, antimicrobial properties of platelet concentrates have been pointed out. In this study, the effect of the platelet concentration, of the activation step and of the presence of plasmatic components on the antimicrobial activity of pure platelet-rich plasma was investigated against gram positive bacteria isolated from oral cavity. The antibacterial activity, evaluated as the minimum inhibitory concentration, was determined through the microdilution two-fold serial method. Results seem to suggest that the antimicrobial activity of platelet-rich plasma against Enterococcus faecalis, Streptococcus agalactiae, Streptococcus oralis and Staphylococcus aureus is sustained by a co-operation between plasma components and platelet-derived factors and that the activation of coagulation is a fundamental step. The findings of this study may have practical implications in the modality of application of platelet concentrates.     

Behaviour of a New Composite Mesh for the Repair of Full-Thickness Abdominal Wall Defects in a Rabbit Model

Introduction

Composite biomaterials designed for the repair of abdominal wall defects are composed of a mesh component and a laminar barrier in contact with the visceral peritoneum. This study assesses the behaviour of a new composite mesh by comparing it with two latest-generation composites currently used in clinical practice.

Methods

Defects (7x5cm) created in the anterior abdominal wall of New Zealand White rabbits were repaired using a polypropylene mesh and the composites: Physiomesh^TM; Ventralight^TM and a new composite mesh with a three-dimensional macroporous polyester structure and an oxidized collagen/chitosan barrier. Animals were sacrificed on days 14 and 90 postimplant. Specimens were processed to determine host tissue incorporation, gene/protein expression of neo-collagens (RT-PCR/immunofluorescence), macrophage response (RAM-11-immunolabelling) and biomechanical resistance. On postoperative days 7/14, each animal was examined laparoscopically to quantify adhesions between the visceral peritoneum and implant.

Results

The new composite mesh showed the lowest incidence of seroma in the short term. At each time point, the mesh surface covered with adhesions was greater in controls than composites. By day 14, the implants were fully infiltrated by a loose connective tissue that became denser over time. At 90 days, the peritoneal mesh surface was lined with a stable mesothelium. The new composite mesh induced more rapid tissue maturation than Physiomesh^TM, giving rise to a neoformed tissue containing more type I collagen. In Ventralight^TM the macrophage reaction was intense and significantly greater than the other composites at both follow-up times. Tensile strengths were similar for each biomaterial.

Conclusions

All composites showed optimal peritoneal behaviour, inducing good peritoneal regeneration and scarce postoperative adhesion formation. A greater foreign body reaction was observed for Ventralight^TM. All composites induced good collagen deposition accompanied by optimal tensile strength. The three-dimensional macroporous structure of the new composite mesh may promote rapid tissue regeneration within the mesh.     

X射线损伤修复交叉互补基因1(XRCC1)单核苷酸多态性与神经胶质瘤易感性关系的meta分析(英文)

目的:采用meta分析方法探讨X射线损伤修复交叉互补基因1(XRCC1)单核苷酸多态性与神经胶质瘤易感性的关系。方法:研究检索了PubMed、EMBASE、ISIWeb ofsciences、ScienceDirect及CNKI数据库从建库至2012年9月关于XRCC1基因多态性与神经胶质瘤相关性的相关文献。合并的OR值及其95%CI用于评估不同基因模型与神经胶质瘤风险的关联强度。采用亚组分析和meta回归分析来探索潜在的异质性来源。结果:研究最终纳入12篇Arg399Gln、8篇Arg194Trp和5篇Arg280His XRCC1位点多态性与神经胶质瘤关系文章用于meta分析。Arg399Gln位点多态性在所有基因模型下合并OR值均有显著意义;Arg194Trp位点多态性在纯合子基因模型和隐性基因模型下合并OR值具有显著意义;未发现Arg280His位点多态性与神经胶质瘤风险相关基因模型。亚组分析和meta回归分析显示Arg399Gln位点多态性的所有基因模型风险仅在亚洲人群当中具有显著意义,亚洲人群的风险显著高于白种人群。Arg194Trp对照组人群不符合Hardy-Weinberg平衡(HWE)可能高估了风险。结论:本研究结果显示XRCC1 Arg399Gln基因多态性仅为亚洲人群的神经胶质瘤风险的候选基因,Arg194Trp基因多态性的风险可能是由于对照组不符合HWE的研究所导致的。