应用改良传统双环法乳房悬吊术矫治乳房下垂

目的:探讨应用改良传统双环法行乳房悬吊术的方法矫治乳房下垂效果。方法:在传统的双环形切口乳房缩小整形术的基础上在皮肤与乳腺的腺体表面之间行广泛剥离后,在乳腺的下半象限正中将腺体垂直切开,将形成的两部分乳腺复合组织瓣向内上及外上方向旋转后互相交叉重叠缝合固定成形,并将乳晕内外环的真皮行荷包缝合。术后将乳房塑形包扎。结果:应用改良传统双环法行乳房悬吊术的方法矫治乳房下垂13例,术后乳房外形美观持久,乳头、乳晕感觉良好,效果满意。结论:应用改良传统手术方法其技术简便易行,组织损伤小,瘢痕不明显,是矫治轻、中度乳房下垂的一种比较理想的方法,值得推广应用。     

Current strategies for osteochondral regeneration: from stem cells to pre-clinical approaches

Damaged cartilage tissue has no functional replacement alternatives and current therapies for bone injury treatment are far from being the ideal solutions emphasizing an urgent need for alternative therapeutic approaches for osteochondral (OC) regeneration. The tissue engineering field provides new possibilities for therapeutics and regeneration in rheumatology and orthopaedics, holding the potential for improving the quality of life of millions of patients by exploring new strategies towards the development of biological substitutes to maintain, repair and improve OC tissue function. Numerous studies have focused on the development of distinct tissue engineering strategies that could result in promising solutions for this delicate interface. In order to outperform currently used methods, novel tissue engineering approaches propose, for example, the design of multi-layered scaffolds, the use of stem cells, bioreactors or the combination of clinical techniques.     

In silico Mechano-Chemical Model of Bone Healing for the Regeneration of Critical Defects: The Effect of BMP-2

The healing of bone defects is a challenge for both tissue engineering and modern orthopaedics. This problem has been addressed through the study of scaffold constructs combined with mechanoregulatory theories, disregarding the influence of chemical factors and their respective delivery devices. Of the chemical factors involved in the bone healing process, bone morphogenetic protein-2 (BMP-2) has been identified as one of the most powerful osteoinductive proteins. The aim of this work is to develop and validate a mechano-chemical regulatory model to study the effect of BMP-2 on the healing of large bone defects in silico. We first collected a range of quantitative experimental data from the literature concerning the effects of BMP-2 on cellular activity, specifically proliferation, migration, differentiation, maturation and extracellular matrix production. These data were then used to define a model governed by mechano-chemical stimuli to simulate the healing of large bone defects under the following conditions: natural healing, an empty hydrogel implanted in the defect and a hydrogel soaked with BMP-2 implanted in the defect. For the latter condition, successful defect healing was predicted, in agreement with previous in vivo experiments. Further in vivo comparisons showed the potential of the model, which accurately predicted bone tissue formation during healing, bone tissue distribution across the defect and the quantity of bone inside the defect. The proposed mechano-chemical model also estimated the effect of BMP-2 on cells and the evolution of healing in large bone defects. This novel in silico tool provides valuable insight for bone tissue regeneration strategies.     

Mimicking natural bio-mineralization processes: a new tool for osteochondral scaffold development

In recent years, the concept of regenerative medicine has gained great importance, particularly in the field of orthopaedics, in which current solutions are based mainly on the replacement of damaged tissues with devices that function only as structural replacements with limited regenerative capacity. New regenerative solutions can be obtained by taking inspiration from nature, which surrounds us with a multitude of organisms endowed with extraordinary performance. In particular, bio-mineralization, which is the basis of the formation of load-bearing structures in vertebrate and invertebrate organisms, can be exploited to achieve innovative devices for the repair and reconstruction of bone and osteo-cartilaginous tissues.     

Stem cell-based tissue engineering in veterinary orthopaedics

Regenerative medicine is one of the most intensively researched medical branches, with enormous progress every year. When it comes to translating research from bench to bedside, many of the pioneering innovations are achieved by cooperating teams of human and veterinary medical scientists. The veterinary profession has an important role to play in this new and evolving technology, holding a great scientific potential, because animals serve widely as models for human medicine and results obtained from animals may serve as preclinical results for human medicine. Regenerative veterinary medicine utilizing mesenchymal stromal cells (MSC) for the treatment of acute injuries as well as chronic disorders is gradually turning into clinical routine. As orthopaedic disorders represent a major part of all cases in veterinary clinical practice, it is not surprising that they are currently taking a leading role in MSC therapies. Therefore, the purpose of this paper is to give an overview on past and current achievements as well as future perspectives in stem cell-based tissue engineering in veterinary orthopaedics.     

组织工程的临床研究——组织工程连载之五

组织工程研究涉及的临床科室包括骨科、普外科、五官科、康复医学科、泌尿科、口腔颌面外科、神经外科、整形外科、胸外科、眼科、肝胆外科、血管外科;涉及的组织器官有:神经组织、肝脏组织、角膜组织、膀胱组织、血液、韧带、耳朵、生殖道、手、脂肪、乳房、心脏、肾脏、胰腺、管状组织(用于建造肠管、食管、气管、血管、肾和尿道等)等.其中皮肤组织、软骨组织、骨组织等的研究应用较为成熟.从最初工程化组织或器官的立项研究到最终批准临床应用,这是一个漫长的过程,需要众多不同学科的科研人员共同努力.随着基础研究和临床应用的深入发展,现代组织工程正在成为治疗组织、器官衰竭的有效疗法和辅助手段.     

Periosteum derived stem cells for regenerative medicine proposals: boosting current knowledge

Periosteum is a thin fibrous layer that covers most bones. It resides in a dynamic mechanically loaded environment and provides a niche for pluripotent cells and a source for molecular factors that modulate cell behaviour. Elucidating periosteum regenerative poten-tial has become a hot topic in orthopaedics. This review discusses the state of the art of osteochondral tissue engineering rested on periosteum derived progenitor cells(PDPCs) and suggests upcoming research direc-tions. Periosteal cells isolation, characterization and migration in the site of injury, as well as their differen-tiation, are analysed. Moreover, the role of cell mecha-nosensing and its contribution to matrix organization, bone microarchitecture and bone stenght is examined. In this regard the role of periostin and its upregulation under mechanical stress in order to preserve PDPC sur-vival and bone tissue integrity is contemplated. The re-view also summarized the role of the periosteum in the field of dentistry and maxillofacial reconstruction. The involvement of microRNAs in osteoblast differentiation and in endogenous tissue repair is explored as well. Fi-nally the novel concept of a guided bone regenerationbased on the use of periosteum itself as a smart mate-rial and the realization of constructs able to mimic the extracellular matrix features is talked out. Additionally, since periosteum can differentiate into insulin produc-ing cells it could be a suitable source in allogenic trans-plantations. That innovative applications would takeadvantage from investigations aimed to assess PDPCimmune privilege.     

Evaluation of safety and efficacy of radiation-sterilized bone allografts in reconstructive oral surgery

Bone grafting allows reconstruction of the atrophied or destroyed alveolar process. In orthopaedics and traumatology allogeneic grafting has been used to restore defects of osseous tissue for over 60 years. In order to improve safety of the graft recipient, sterilized allogeneic grafts have been use. The aim of the study was to assess the direct and long-term outcomes following augmentation of atrophied alveolar processes with the use of radiation-sterilized allogeneic bone grafts. Sixty-eight patients were surgically treated between 2004 and 2011: 29 underwent open sinus floor elevation, post-extraction alveoli augmentation was performed in 16 subjects and 23 underwent reconstruction of the atrophied alveolar process. Augmentation of bone defects used bone granulate in 63 patients and bone blocks stabilized with titanium screws in 5 patients. PRF membranes collected from the patient’s blood were also used in all the procedures. In each of the cases optimal dimensions of the alveolar process were obtained allowing embedment of BIOMET 3I dental implant/-s. In all the patients the defects were successfully restored with implant-supported prostheses. Radiation-sterilized allogeneic bone grafts proved to be safe and effective for the patients and manageable for the surgeon constituting a good alternative to autogeneic material.     

The immune system and age

Basing on numerous facts, obtained during last years at investigation of the immune system organs, a definite idea has been formed on peculiarities of their structure during certain stages of human ontogenesis. The immune organs appear early in embryogenesis and by birth they have reached their morphological maturation. This is evident as formation of diffuse lymphoid tissue in lymphoid noduli, that can have germinative centers, where young cells of the lymphoid line are formed. The immune system organs develop especially quickly after birth during first years of the postnatal ontogenesis. The peak in development of the organs of immunogenesis, amount and size of the lymphoid noduli occurs during the childhood and adolescent age. Each immune organ has its peculiarities that are determined by their place in the organism, value and intensity of antigenic effect. Beginning from the adolescence and youth amount of the lymphoid tissue and lymphoid noduli in the organs decreases, in their place connective and adipose tissue grows out.     

Ensemble averaging and multiple statistical testing of EMG activities of cyclically repeated body motions. A tool for muscle function analysis in experimental and clinical orthopaedics.

Coupled with suitable computerized signal recording and processing methods surface electromyography can be a powerful tool for the analysis of muscle activity in specific body movements. It can be used for this purpose in experimental and in clinical diagnostic orthopaedics as well as in physiotherapy. We describe in this paper a motion analysis system comprising this feature. It has been employed for the diagnosis of the basic angular kinematics and muscle function in human gait and other cyclically repeatable movements of the human locomotive system. Changes in the temporal characteristics of the movements and the muscle activity due to changed physical or experimental conditions can be systematically investigated this way. Such changes can be the result of surgical and/or conservative orthopaedic therapy, a long term physiotherapeutic program, or modified walking conditions as in experimental orthopaedics. They are displayed and validated by signal ensemble averaging and subsequent multiple statistical testing (e.g. by a suitably adapted Bonferroni criterion). The efficiency of the system is demonstrated by an exemplary gait analysis of selected kinematic and muscular effects caused by an experimental simulation of a leg length inequality.     

Biomechanical evaluation on a novel design of biodegradable embossed locking compression plate for orthopaedic applications using finite element analysis

Biomechanics and Modeling in Mechanobiology - In orthopaedics, conventional implant plates such as locking compression plate (LCP) made from non-biodegradable materials play a vital role in the...     

Molecular diagnosis of prosthetic joint infection. A review of evidence

Prosthetic joint infection (PJI) diagnosis includes several classes of verification. Among them, only a few have a stronger independent value, namely intraarticular purulence and communicating fistulas. Other diagnostic methods require careful test combinations, analysis, and interpretation. Molecular based techniques using the polymerase chain reaction (PCR) seem to be a promising PJI diagnostic modality due to its excellent sensitivity, specificity, positive predictive value, and speed. Most of the recent reviewers are in agreement that molecular diagnosis has enough potential for future application in orthopaedics even if there are only a few heterogeneous studies fully supporting this concept. Conversely, at least one study has been published with significantly worse results (sensitivity and specificity less than 0.75). The lack of supporting evidence in the published studies may be closely related to varying PCR laboratory procedures, inappropriate reference standards, and other methodological shortcomings among research centers. It is not yet justifiable to firmly include molecular methods into the present PJI diagnostic schemes. The orthopaedic community must await the results of well-organized ongoing studies before considering inclusion of molecular diagnostics as a PJI diagnostic method. The aim of this paper was to make a survey of current PJI molecular diagnostic techniques in orthopaedics.     

Confocal laser scanning microscopy in orthopaedic research

Confocal laser scanning microscopy (CLSM) is a type of high-resolution fluorescence microscopy that overcomes the limitations of conventional widefield microscopy and facilitates the generation of high-resolution 3D images from relatively thick sections of tissue. As a comparatively non-destructive imaging technique, CLSM facilitates the in situ characterization of tissue microstructure. Images generated by CLSM have been utilized for the study of articular cartilage, bone, muscle, tendon, ligament and menisci by the foremost research groups in the field of orthopaedics including those teams headed by Bush, Errington, Guilak, Hall, Hunziker, Knight, Mow, Poole, Ratcliffe and White. Recent evolutions in techniques and technologies have facilitated a relatively widespread adoption of this imaging modality, with increased "user friendliness" and flexibility. Applications of CLSM also exist in the rapidly advancing field of orthopaedic implants and in the investigation of joint lubrication.     

Actividad ortogeriátrica en los hospitales públicos de Castilla y León: descripción y revisión de la literatura

The benefits of the collaboration between orthopaedics and geriatrics in the management and care of elderly patients admitted with hip fracture have been widely demonstrated. A questionnaire was sent to all hospital geriatricians of Castilla y León in order to determine the characteristics this collaboration between orthopaedics and geriatrics in the public hospitals of Castilla y León. They were asked about the type of collaboration with orthopaedics in the care of the elderly patient admitted with hip fracture and details of the treatment of the complications. Most of the hospitals maintain a high level of orthogeriatric collaboration with geriatricians, and the geriatrician attends to most of the medical complications of these patients. The average hospital stay is 10 days, with a surgical delay of 3 days. Management of the most frequent clinical problems in hospitals of Castilla y León are detailed in this article, comparing them with the latest articles and current recommendations from clinical practice guides.     

Gene therapy for cartilage defects

Focal defects of articular cartilage are an unsolved problem in clinical orthopaedics. These lesions do not heal spontaneously and no treatment leads to complete and durable cartilage regeneration. Although the concept of gene therapy for cartilage damage appears elegant and straightforward, current research indicates that an adaptation of gene transfer techniques to the problem of a circumscribed cartilage defect is required in order to successfully implement this approach. In particular, the localised delivery into the defect of therapeutic gene constructs is desirable. Current strategies aim at inducing chondrogenic pathways in the repair tissue that fills such defects. These include the stimulation of chondrocyte proliferation, maturation, and matrix synthesis via direct or cell transplantation-mediated approaches. Among the most studied candidates, polypeptide growth factors have shown promise to enhance the structural quality of the repair tissue. A better understanding of the basic scientific aspects of cartilage defect repair, together with the identification of additional molecular targets and the development of improved gene-delivery techniques, may allow a clinical translation of gene therapy for cartilage defects. The first experimental steps provide reason for cautious optimism.     

The US Navy Tissue Bank: 50 Years on the Cutting Edge

The US Navy Tissue Bank was established in 1949 by Dr. George Hyatt, an orthopaedic surgeon at the Naval Medical Center in Bethesda, Maryland. The Navy program was the first of its kind in the world and established many of the standards that are followed today. During the 1950s, the identification of appropriate donor criteria for tissue donation, the development of procurement and processing methods, the establishment of a graph registry and documentation and the clinical evaluation of a variety of tissues were pioneered at this facility. Cryopreservation, freeze-drying, irradiation sterilization of tissue, as well as immunological principles of tissue transplantation, were developed during the 50 years of research and development by Navy scientists. Organ preservation, cadaveric bone marrow recovery and immunosuppressive protocols were also developed at the Navy Tissue Bank. The Navy was also instrumental in the establishment of the National Marrow Donor Program and the American Association of Tissue Banks in the US.Although the Navy Tissue Bank has ceased activity after 50 years of excellence, it should be recognized as the first standard setter for the world community of tissue banks.     

Experimental and clinical study of the demineralized bone allografts manufactured in the tissue bank of CITO

The technology for producing demineralized bone allografts (DBA) with definable degree of demineralization and sterilization by high energy electron bean was developed in the tissue bank of Central Institute of Traumatology and Orthopaedics (CITO). The authors consider the technology to be one of the ways of producing demineralized bones. The results of the experiments show that time of demineralization process as well as the absorption dose of radioactive high energy electron beam change substantially mechanical toughness and osteoinductive properties of DBA. Mechanical properties of DBA were tested by the universal testing machine 'Zwick 1464'. Quantitative assessment of DBA osteoinductive properties resulted from the investigation of DBA samples in the culture of stromal precursor bone marrow cells and in the culture of human skin fibroblasts. Cloning efficiency of fibroblasts was considered as indecies of proliferative potential of stromal bone marrow cells, i.e. osteogenic precursor cells. The growth of the cell mass after definite time as well as the index of ³H-timidin marked cells within biological inductor were considered as indecies of proliferative potential of skin fibroblasts. The obtained results showed, that inductive properties of allografts improve when the degree of their demineralization increases whereas the dose of high energy electron radiation decreases. Mechanical toughness of DBA deteriorates when both degree of their demineralization and radiation doses increase. This emphasizes the importance of optimizing technological stages in DBA producing. Since 1998 DBA have been used in Russian clinics for bone plasty in traumatology and orthopaedics, maxilla-facial surgery, ophthalmology, and neurosurgery. The resulting analysis is based on case histories of 257 patients operated from March 1998 to July 2002. The majority of patients were children and teenagers of 3–18 years old with prime tumors, tumor-like and systemic inherited diseases of skeleton, post-traumatic complications. Observation periods were from 1.5 to 5 years and 10 months. Good and satisfactory results were obtained in 93.4% cases. This revised version was published online in July 2006 with corrections to the Cover Date.     

Drosophila metalloproteases in development and differentiation: the role of ADAM proteins and their relatives

ADAM metalloproteases are membrane bound glycoproteins that control many biological processes during development and differentiation, mainly by acting as ectodomain sheddases. The Drosophila genome contains five genes that code for classical ADAM proteins which are characterized by a highly conserved domain structure with the respective catalytic domains facing the extracellular space. More than 50 genes encode related proteins such as those that have lost their primary enzymatic activity while retaining, e.g., their adhesive properties. The physiological relevance of many Drosophila ADAMs and their relatives is still unknown, however for others, a striking role during organogenesis and tissue maintenance has been demonstrated during the last few years. We have carried out genetic screenings combined with candidate approaches, aiming to identify new components involved in cardiogenesis and muscle differentiation. Herein we summarize our results with a particular focus on metalloproteases with known or potential roles in tissue differentiation.     

Endothelium--an organized monolayer of highly specialized cells

Research on endothelial cells has expanded in near exponential fashion during the last few years and has become a noteworthy field of both clinical and experimental investigation. Endothelium is indisputably a highly specialized tissue which mediates and controls many physiological and pathological processes. It can no longer be regarded as a passive semipermeable barrier between blood and tissues. The endothelial cell--the structural unit of endothelium--is, consequently, a metabolically highly active cell with many unique characteristics.     

棉花体细胞胚胎发生的研究进展

经过30多年的发展, 已经在多个不同的棉花品种中获得了体细胞胚, 并再生成苗。但由于体细胞胚胎发生往往受多种因素影响, 如何从愈伤组织高效率地转化为胚性愈伤组织依然是限制棉花组织培养与遗传转化的关键问题之一。本文概述了棉花体细胞胚胎发生的研究进展, 分别从棉花体细胞胚胎发生的起源、影响棉花体细胞胚胎发生的内外因素以及寻找棉花体细胞胚胎发生特异表达基因等几方面进行综述, 并对研究中存在的问题进行了讨论。