Effectiveness of total knee arthroplasty using three-dimensional printing technology for knee osteoarthritis accompanied with extra-articular deformity

目的探讨3D打印技术辅助人工全膝关节置换术(total knee arthroplasty,TKA)治疗合并关节外畸形的膝骨关节炎(knee; osteoarthritis,KOA)的临床疗效。方法2013年3月2015年12月,收治15例(18膝)合并关节外畸形的KOA患者。男6例(6; 膝),女9例(12膝);年龄55~70岁,平均60.2岁;病程7~15年,平均10.8年。单膝12例,双膝3例。膝关节学会评分系统(KSS)临床; 评分为(57.441.06)分,功能评分为(60.881.26)分。膝关节活动度为(72.220.18)°。下肢力线偏移(18.890.92)°; 。合并股骨侧畸形8例(10膝),胫骨侧畸形5例(5膝),股骨侧及胫骨侧畸形2例(3膝)。术前3D打印骨骼模型、截骨导航模板并设计手术方案,选择合; 适的膝关节假体后实施TKA。结果手术时间65~100 min,平均75.6 min;术中出血量50~150 mL,平均90.2; mL。术后均未出现切口愈合不良、感染、血栓等并发症。患者均获随访,随访时间12~30个月,平均22个月。末次随访时,X线片示假体位置均良好,未发; 现松动、下沉;下肢力线偏移(2.000.29)°,与术前比较差异有统计学意义(t=13.120,P=0.007);KSS临床评分为(87.500; .88)分、功能评分为(81.941.41)分,与术前比较差异有统计学意义(t=27.553,P=0.000;t=35.551,P=0.000); ;膝关节活动度为(101.941.42)°,与术前比较差异有统计学意义(t=31.633,P=0.000)。结论对于合并关节外畸形的KOA,采用; 3D打印技术辅助TKA,可达到个体化治疗、降低手术难度,有效矫正畸形,恢复患者膝关节功能的目的。Objective To evaluate the effectiveness of total knee arthroplasty (TKA); using three-dimensional (3D) printing technology for knee osteoarthritis; (KOA) accompanied with extra-articular deformity. Methods Between March; 2013 and December 2015, 15 patients (18 knees) with extra-articular; deformity and KOA underwent TKA. There were 6 males (6 knees) and 9; females (12 knees), aged 55-70 years (mean, 60.2 years). The mean; disease duration was 10.8 years (range, 7-15 years). The unilateral knee; was involved in 12 cases and bilateral knees in 3 cases. The clinical; score was 57.441.06 and the functional score was 60.881.26 of Knee; Society Score (KSS). The range of motion of the knee joint was; (72.220.18)°. The deviation of mechanical axis of lower limb was; (18.890.92)° preoperatively. There were 8 cases (10 knees) with; extra-articular femoral deformity, 5 cases (5 knees) with; extra-articular tibial deformity, and 2 cases (3 knees) with; extra-articular femoral and tibial deformities. Bone models and the; navigation templates were printed and the operation plans were designed; using 3D printing technology. The right knee joint prostheses were; chosen. Results The operation time was 65-100 minutes (mean, 75.6; minutes). The bleeding volume was 50-150 mL (mean, 90.2 mL). There was; no poor incision healing, infection, or deep venous thrombosis after; operation. All patients were followed up 12- 30 months (mean, 22; months). Prostheses were located in the right place, and no sign of; loosening or subsidence was observed by X-ray examination. At last; follow-up, the deviation of mechanical axis of lower limb was; (2.000.29)°, showing significant difference when compared with; preoperative one (t=13.120, P=0.007). The KSS clinical score was; 87.500.88 and function score was 81.941.41, showing significant; differences when compared with preoperative ones (t=27.553, P=0.000;; t=35.551, P=0.000). The range of motion of knee was (101.941.42)°,; showing significant difference when compared with preoperative one; (t=31.633, P=0.000). Conclusion For KOA accompanied with extra-articular; deformity, TKA using 3D printing technology has advantages such as; individualized treatment, reducing the difficulty of operation, and; achieving the satisfactory function

补肾健脾方影响高脂肪饮食骨质疏松模型大鼠脂代谢及瘦素的变化

背景:绝经也可导致体内瘦组织与脂肪成分的改变,现阶段发现骨质疏松在肥胖的老年人中的发生率要大于非肥胖者,由此推断瘦素可能是骨质疏松症发病机制中的一个重要调节因素。目的:探讨补肾健脾方对高脂肪饮食骨质疏松大鼠脂代谢及瘦素的影响。方法:将6月龄SPF级雌性SD大鼠220只随机分成模型组170只和假手术组50只。模型组行双侧卵巢结扎切除术,假手术组除未行卵巢结扎切除外,其余步骤同模型组。手术后12周,模型鉴定成功后,手术组随机分成正常饮食模型组、高脂饮食模型组、高脂饮食健骨颗粒组和高脂饮食辛伐他丁组各40只。各组于术后第13周开始给药,健骨颗粒组给予健骨颗粒2 g/(kg·d),生理盐水2 mL溶解后灌胃,辛伐他丁组给予辛伐他丁100μg/(kg·d)灌胃,假手术组和正常饮食模型组以2 mL生理盐水灌胃,1次/d。于用药2,6,12,24周后测体质量,取血清、腰椎和股骨近端备用。双能X射线测定右侧胫骨骨密度,ELISA法测定血清骨钙素、血清抗酒石酸酸性磷酸酶5b(TRACT-5b)、总胆固醇、三酰甘油、瘦素、瘦素受体的水平,q PCR法测定大鼠骨组织瘦素、瘦素受体m RNA表达。结果与结论:①高脂饮食健骨颗粒组大鼠的体质量高于同期正常饮食模型组和高脂饮食模型组,但低于假手术组和高脂饮食辛伐他汀组,同时表达的瘦素、瘦素受体、骨钙素水平均高于正常饮食模型组和高脂饮食模型组,TRACT-5b、胆固醇、三酰甘油的浓度均低于正常饮食模型组和高脂饮食模型组,各组比较差异均有显著性意义(P <0.05);②结果表明,补肾健脾方可以调整大鼠脂代谢紊乱、降低血液黏滞度、改善血管壁结构的同时还能通过上调大鼠血清和骨组织中瘦素、瘦素受体的表达,改善大鼠骨代谢水平,防治原发性骨质疏松症。福建省自然科学基金(2017J01332),项目负责人:林煜;;福州市卫生系统科技项目(2017-S-wq15),项目负责人:李平~

Study of the effect of Strong-bone granules on the differentiation of ROS1728 osteoblasts with silenced ER expression

目的探讨健骨颗粒对成骨细胞中ERalpha介导的TERT信号通路的调控作用。方法采用雌激素受体拮抗剂ICI182780(Faslodex)阻断成; 骨细胞中雌激素受体alpha(ERalpha)的表达,建立ER抑制的大鼠成骨细胞株ROS1728细胞模型,采用酶联免疫吸附法(ELISA)检测成; 骨细胞液中碱性磷酸酶(alkaline phosphatase,ALP) 、骨钙素(osteocalcin,BGP); 、Ⅰ型胶原(collagen I,Col Ⅰ)的含量。采用实时荧光定量SYBR; GREEN法检测ERE、ERalpha、c-MYCmRNA的表达。采用Western Blot检测TERT、ERalpha、c-; MYC蛋白的表达。结果ELISA法检测结果显示:随着干预时间的延长,培养液中的ALP、BGP、ColⅠ的含量逐渐上升。其中对照组3种信号因子的含; 量最高血,雌激素组次之,健骨颗粒组再次之,模型组最低,各组比较差异有统计学意义(P < 0.05),; 4组TERT、ERalpha、c-MYCmRNA及蛋白表达量情况以对照组的蛋白表达含量最高,雌激素组次之,健骨颗粒组再次之,模型组最低。各组比较; 均有统计学意义(P < 0.05); 。结论雌激素介导TERT信号通路及其相关因子与成骨细胞分化的关系密切,而补肾健脾中药健骨颗粒可通过雌激素介导TERT信号通路促进成骨细胞分化。Objective To investigate the effect of Strong-bone granules on the; regulation of TERT signaling pathway mediated by ER alpha in; osteoblasts. Methods The estrogen receptor antagonist ICI182780; (Faslodex) was used to inhibit the expression of ER in osteoblasts and; to establish the ER-silenced model of rat osteoblast cell line ROS1728.; Serum ALP,BGP,and Col I were determined using enzyme-linked; immunosorbent assay. The mRNA expression of ERE,ERalpha,and c-MYC was; determined using real time quantitative SYBR GREEN assay. The protein; expression of ERE,ERalpha,and c-MYC was detected using Western blotting.; Results The results of ELISA showed that the content of ALP,BGP,and Col; in the culture medium increased gradually with the prolonging of; intervention time. The levels were the highest in the control group,then; followed in estrogen group,Strong-bone granules group,and the model; group,and the difference among the groups was significant (P < 0.05).; The mRNA and protein expression of TERT,ER alpha,and c-MYC was the; highest in the control group,then followed in estrogen group,Strong-bone; granules group,and the model group,and the difference among the groups; was significant (P < 0.05). Conclusion The estrogen mediated TERT; signaling pathway and its related factors are closely related to the; differentiation of osteoblasts. Strong-bone granules promote osteoblast; differentiation through estrogen mediated TERT signaling pathway.国家自然科学基金; 福建省卫生厅中医课题; 福州市卫生系统科技项

Effects of Serum Medicated with Duhuo Jisheng Decoction on the Induced Degeneration of Articular Chondrocytes in Vitro Culture Based upon “caveolin-p38MAPK” Signal Pathway

目的:观察独活寄生汤含药血清对兔退变软骨细胞“CAVEOlIn-P38MAPk“信号通路的调控作用,探讨独活寄生汤治疗骨关节炎的作用机制。方法:将20只3月龄新西兰兔随机分为生理盐水组(空白血清组)和独活寄生汤组(含药血清组),每组10只。分别在24 H、36 H、48 H不同采血时间点采集独活寄生汤含药血清和空白血清,将5%、10%、15%、20%不同浓度两种血清作用于体外培养第2代软骨细胞,确定含药血清最佳干预条件;建立体外退变软骨细胞模型,分别给予独活寄生汤含药血清(含药血清组)和空白血清(空白血清组)干预36 H,收集软骨细胞,运用WESTErn blOT法检测血清干预后退变软骨细胞CAVEOlIn-1、P38、P-P38蛋白表达,rT-PCr法检测血清干预后退变软骨细胞白细胞介素(Il)-1β、肿瘤坏死因子(Tnf)-α、基质金属蛋白酶(MMP)-3、MMP-13、CAVEOlIn-1 M rnA表达。结果:浓度为15%的36 H采血时间点含药血清的促增殖作用最明显;退变软骨细胞中存在“CAVEOlIn-P38MAPk“信号通路的激活,独活寄生汤含药血清可抑制CAVEOlIn-1、P-P38蛋白表达及Il-1β、Tnf-α、MMP-3、MMP-13、CAVEOlIn-1 M rnA的表达,差异有统计学意义(P<0.05)。结论:独活寄生汤能通过抑制“CAVEOlIn-P38MAPk“信号通路的激活及其下游效应分子,从而有效抑制软骨细胞凋亡。Objective:To observe the effects of serum medicated with Duhuo Jisheng Decoction on the induced degeneration of articular chondrocytes in vitro culture based upon "caveolin-p38MAPK" signal pathway and probe the mechanism of Duhuo Jisheng Decoction in the treatment of osteoarthritis.Methods:20 March old New Zealand rabbits were randomly divided into normal saline group(blank serum group)and Duhuo Jisheng Decoction group(drug containing serum group),10 rats in each group.The second generation of cartilage cells was cultured in vitro using different time points of sample collection such as 24 h,36 h and 48 h,serums medicated with 5%,10%,15% and 20% concentrations of Duhuo Jisheng Decoction and blank serums.The best intervention time of medicated serum was determined,which was then used to deal with the degenerating chondrocytes.The degenerated cartilage cell models in vitro were established,which were intervened by the serum medicated with Duhuo Jisheng Decoction(drug containing serum group)and the blank serum(blank serumgroup)after 36 h,collecting chondrocytes.The Western Blot method was used to detect the expression of degenerated cartilage cells caveolin-1 and p-p38 protein after serum intervention.The RT-PCR method was usedto detect the expression of degenerated cartilage cells IL-1β,TNF-α,MMP-3,MMP-13 and caveolin-1 m RNA after serum intervention.Results:The concentration of 15% and 36 h sampling time point serum on the proliferation;the activation of "caveolin-p38MAPK" signaling pathway in the degeneration of cartilage cell,Duhuo Jisheng decoction containing serum can inhibit the expression of caveolin-1,p-p38 protein expression and IL-1β,TNF-α, MMP-3,MMP-13,caveolin-1,m RNA,the difference was statistically significant(P < 0.05).Conclusion:Duhuo Jisheng decoction can inhibit the "caveolin-p38MAPK" signal pathway and its downstream effector molecules, which can effectively inhibit the apoptosis of cartilage cells.国家自然科学基金资助项目(81302986); 福建省卫生厅青年科研课题资助计划项目(2012-2-69); 福建省自然科学基金(2013J01389); 福州市卫生系统科技计划(2013-S-wq6

一期翻修术治疗膝关节假体周围感染的疗效分析

目的探讨一期膝关节翻修术治疗膝关节假体周围感染的安全性及有效性。方法选取2015年1月～2018年6月厦门大学附属福州第二医院因膝关节假体周围感染接受一期膝关节翻修术的患者28例。收集患者的人口统计学资料、感染病原,并回顾性分析患者术前及术后KSS、HSS与OKS评分及影像学资料,评估膝关节假体周围感染接受一期膝关节翻修术的安全性及临床疗效。结果 28例接受一期膝关节翻修术的患者,男14例,女14例,平均年龄(65.3±10.1)岁,截止到末次随访,除1例患者死亡(死于心肌梗死)失访外,其余27例患者平均随访25.7个月(13～39个月),未发现假体松动及假体周围感染复发。患者术前KSS评分平均(34.19±13.00)分,末次随访时平均(76.37±16.46)分;术前HSS评分平均(36.03±13.39)分,末次随访时平均(71.24±16.39)分;术前OKS评分平均(16.62±3.47)分,末次随访时平均(27.43±6.02)分,差异有统计学意义(P <0.05)。结论在选择合适适应证情况下,膝关节置换术后假体周围感染的患者通过一期膝关节翻修术可以有效控制感染并重建膝关节功能。福建省自然科学基金项目(2017J01333

Study of the gene expression profile in the bone tissue with kidney yin deficiency syndromes in primary osteoporosis

目的通过检测原发性骨质疏松症患者骨组织基因表达谱的差异,探讨原发性骨质疏松症肾阴虚证相关基因的信息学特征。方法随机选择骨质疏松症患者,中医辨证分型为肾阴虚证组3例、肾阳虚证组3例、无肾虚证组3例,并选择正常骨密度人群3例设为正常对照组。用人全基因组表达谱芯片检测4组人群骨组织基因表达谱,筛选共同的差异表达基因,并对这些差异表达基因进行基因通路等相关功能分析。结果肾阴虚证组与正常对照组、肾阳虚证组、无肾虚证组的差异表达基因分别为2378、4026、4071条,肾阴虚证组与其他3组比较共同的差异表达基因有344条,这些差异基因参与免疫调节、矿物质吸收、激素合成、组氨酸代谢等11条信号通路。结论原发性骨质疏松症肾阴虚证的相关基因主要与免疫调节、激素合成、组氨酸代谢、矿物质吸收等信号通路相关。Objective To investigate the characteristics of genes expression profiles of kidney yin deficiency in primary osteoporosis by analyzing the difference of gene expression profiles in the bone tissues in patients w ith primary osteoporosis.Methods Osteoporotic patients were randomly selected.All the patients were divided into kidney yin deficiency group,kidney yang deficiency group,and non-kidney deficiency group according the syndrome differentiation of traditional Chinese medicine.Each group had 3 patients.Another 3 people w ith normal bone mineral density( BMD) w ere selected as normal control.Gene expression profiles of the bone tissues in all 4 groups w ere detected using the human genome-w ide expression profile chip.The differentiated expression genes w ere screened,and the analysis of the related functions of these genes including the pathw ays w as conducted.Results Compared w ith that in kidney yang deficiency group,non-kidney deficiency group,and normal control group,the number of differentiated expression genes in kidney yin deficiency group w as 2378,4026,and 4071,respectively.Compared w ith that in these 3 groups,the number of common differentiated expression gene in kidney yin deficiency group w as344.These genes w ere involved in 11 pathw ays,including immunoregulation,mineral absorption,hormone synthesis,and histidine metabolism.Conclusion Related genes of kidney yin deficiency syndromes in primary osteoporosis are mainly related to the signal pathw ays such as immunoregulation,hormone synthesis,histidine metabolism and mineral absorption.国家自然科学基金(81173280); 福建省科技厅省属公益类科研院所基本科研专项(2011R1038-5); 福建省卫生厅创新课题(2011-CX-30); 福建省卫生厅青年基金项目(2010-1-31

Estimation of genetic parameters of growth traits and genetic gain of F5 generation of scallop Hongmo No. 1

Argopecten irradians concentricus, natively distributed along the Atlantic coast of the United States, has advantages of fast growth, short growth cycle, and high meat yield. It was introduced into China mainland in 1991 and in 2001 its large-scale aquaculture began in the Beibu Gulf area. More than 20 years since the introduction of A. irradians concentricus, as the number of breeding generations increased, the characteristics of the breeding population deteriorated seriously reflected in small individuals, low survival rates, and low meat yields. To solve the problem of germplasm degradation of A. irradians concentricus, this research team hybridized A. irradians concentricus with the scallop Bohai Red in 2016, and successfully obtained hybrid offspring. After four generations of breeding, a new strain of scallop Hongmo No. 1 was obtained. Hongmo No. 1 has the characteristics of a fast growth rate, high survival rate, and high temperature resistance, and has completely adapted to the environment of Beibu Gulf in the south of China, so it has a good prospect of popularization and breeding. Although Hongmo No. 1 has been bred for multiple generations, the genetic parameters of its growth-related traits are unknown and whether it still has breeding potential is unclear. As a result of successive selection in a closed population, genetic parameters varied between different generations of selected strains. Obtaining estimates of genetic parameters and genetic gain of growth-related traits of scallop Hongmo No. 1, which has experienced numerous generations of selection, is of great significance for subsequent breeding. To evaluate the breeding effect of the new scallop strain Hongmo No. 1, this study compared the selected line and a non-selected line in the F4 generation of Hongmo No. 1 and evaluated the genetic parameters and genetic gain of F5 growth-related traits. The results indicated that in the F5 generation of Hongmo No. 1 there was no significant difference in the survival rate between the selected line and the non-selected line (P>0.05), but the growth traits of the selected line were significantly better than those of the non-selected line (P<0.05). The coefficients of variation of quality traits of the two populations of Hongmo No. 1 F5 were 14.60%-28.30%, showing potential for successive selective breeding. The genetic gain of shell length, shell height, shell width, body weight, adductor muscle weight, soft tissue weight, and shell weight in the F5 generation were 7.25%, 7.13%, 4.86%, 25.42%, 31.60%, 27.70%, and 21.29%, respectively. The realized heritability of shell length, shell height, shell width, body weight, adductor muscle weight, soft tissue weight, and shell weight in the F5 generation were 0.37, 0.36, 0.25, 0.36, 0.32, 0.38, and 0.32, respectively, which are moderate levels of heritability. The results of this study showed that the growth traits of the selected line were better than those of the non-selected line, both of which showed a large coefficient of variation for quality traits, moderate mean genetic gain, and medium realized heritability. These results indicate that the genetic improvement of A. irradians concentricus, using first hybridization and then sub-breeding, has achieved good results. These results provide a basis for further breeding of growth traits in scallop Hongmo No. 1

Physiological effects of ocean acidification and nano-silver on juvenile jellyfish Rhopilema esculenta

Ocean acidification and nanometals pose a threat to marine animals,but the effects of ocean acidification and nanometal stress on jellyfish have not been reported. This study took the large edible jellyfish Rhopilema esculenta from the coastal China as the research object,and the physiological effects of acidification and AgNPs stress on the juvenile jellyfish were studied. The juvenile jellyfishes were exposed to two levels of pH(8.10 and 7.60)and three concentrations of AgNPs(0,20,and 200 mug /L)for 14 days,and their growth,swimming behavior and physiological indicators were measured. The results indicated that seawater acidification could significantly enhance the activities of catalase(CAT)and ion transport enzymes(Ca~(2+)-ATPase and Na~+K~+-ATPase),thereby alleviating the oxidative stress caused by AgNPs on juvenile jellyfish. AgNPs inhibited the activities of acid phosphate phosphatase(ACP),alkaline phosphatase(AKP)and superoxide dismutase(SOD)of juvenile jellyfish and affected energy metabolism,resulting in slow growth rate and redusced pulsation rate. With the increase of AgNPs exposure concentration,acidification led to higher levels of lipid peroxidation and a significant increase inmalondialdehyde(MDA)in jellyfish. This study identified the different physiological responses of juvenile jellyfish to the acidification and AgNPs and provided a reference for evaluating changes in Rhopilema esculenta populations under changing marine environments

直接前侧入路全髋关节置换是否导致髋臼前壁偏心磨挫?（英文）

背景:目前有学者认为直接前侧入路行髋关节置换术会导致髋臼前壁的过度磨挫,但是缺少确切的临床证据来证实。目的:试验拟通过髋臼CT影像测量,观察比较直接前侧入路与后外侧入路行全髋置换髋臼前后壁偏心磨挫情况的差异。方法:纳入2015年10月至2017年12月在厦门大学附属福州第二医院由同一主刀医生行初次关节置换患者共60例,直接前侧入路组及后外侧入路组各30例(各占50%)。采用影像阅读系统收集并测量所有病例手术前后髋臼前壁、后壁横断面积,髋臼前后壁高、髋臼横径及髋臼前倾角的变化,以评价髋臼骨储量相关指标的变化。参加研究的人员均具有骨科手术5-10年的临床经验,手术医生职称为副主任医师以上。试验经厦门大学附属福州第二医院伦理委员会批准,批准时间2017-06-01。试验方案经患者和相关家属知情同意,并签署知情同意书。结果与结论:术后髋臼骨储量相关指标变化:两组术后前后壁横断面积、髋臼前后壁高度均小于术前(P0.05)。直接前侧入路组术后髋臼前壁面积高于后外侧入路组(P0.05)。结果证实:与后外侧入路行全髋置换相比,直接前侧入路术后髋臼前壁面积变大,其他髋臼前后壁骨储量参数指标变化不显著,试验推测直接前侧入路行全髋关节置换并不是导致髋臼前壁偏心磨挫的危险因素,未来还需多中心、前瞻性的随机对照研究来进一步验证。the Natural Science Foundation of Fujian Province,No.2017J01333(to FEY)~