外周性原始神经外胚层瘤的临床病理及免疫组织化学特征

目的:探讨外周性原始神经外胚层瘤(peripheral primitive neuroectodrmaltumour,pPNET)的临床病理及免疫组织化学特征。方法:对8例pPNET进行组织形态学观察和组化及免疫组化染色,并复习病史。结果:8例pPNET患者临床表现为进行性增大的局部肿块及其继发症状。影像学检查显示病变为密度增高的软组织影或溶骨性骨组织破坏。光镜下,瘤细胞为形态均一的小圆形或卵圆形,被纤维结缔组织所分隔成实性片状或巢状。部分病例可见典型Homer-Wright菊形团及/或菊形团排列趋势,1例伴明显神经细胞分化。免疫组化:8例pPNET中,CD99、Syn和NSE 3种标记阳性率较高,分别为7/8、6/8及7/8,Vim和CgA分别为5/8。Syn和NSE 2项阳性6例,CD99和Syn或NSE 2项阳性7例,3项均阳性6例。结论:pPNET是一种好发于青少年、形态原始和少见的高度恶性肿瘤,CD99、NSE及Syn的联合表达有助于pPNET的诊断和鉴别诊断。

Recent Progress in Cartilage Tissue Engineering--Our Experience and Future Directions

Given the limited spontaneous repair that follows cartilage injury, demand is growing for tissue engi- neering approaches for cartilage regeneration. There are two major applications for tissue-engineered cartilage. One is in orthopedic surgery, in which the engineered cartilage is usually used to repair cartilage defects or loss in an articular joint or meniscus in order to restore the joint function. The other is for head and neck reconstruction, in which the engineered cartilage is usually applied to repair cartilage defects or loss in an auricle, trachea, nose, larynx, or eyelid. The challenges faced by the engineered car- tilage for one application are quite different from those faced by the engineered cartilage for the other application. As a result, the emphases of the engineering strategies to generate cartilage are usually quite different for each application. The statuses of preclinical animal investigations and of the clinical translation of engineered cartilage are also at different levels for each application. The aim of this review is to provide an opinion piece on the challenges, current developments, and future directions for cartilage engineering for both applications.

Soft tissue recurrence of giant cell tumor of bone: A report of two cases and literature review

We investigated the clinical features of soft-tissue recurrence in giant cell tumor of bone （GCTB）. Among 106 cases with GCTB in our hospital, there were 2 cases occurring soft-tissue recurrence which histories were reported. These two soft-tissue recurrences occurred with the interval of 6.9 years and 2.5 years respectively from pdmary diagnosis. The clinical presentation was nonspecific masses in soft tissue. Radiographic ossification was not found at periphery or within the masses. Through pathological examination peripheral ossification was found in 1 case and malignant transformation occurred in the other case. Through retrieving and reviewing literatures in PubMed, 19 cases of soft-tissue recurrence with detailed materials were collected and analyzed. Soft-tissue recurrence of GCTB is a rare episode which reflects its locally aggressive nature, the reasons of which are tumor cells implantation and tumor residual. Ossification at periphery or in the masses can be considered as a pathognomonic character of this episode in radiographic and pathohistological examination. The prevention lies in determining tumor extension preoperatively, proper non-tumor manipulations, removing the tumor and irrigating operative wound as completely as possible.

Cartilage and facial muscle tissue engineering and regeneration： a mini review

Cartilage and facial muscle tissue provide basic yet vital functions for homeostasis throughout the body, making human survival and function highly dependent upon these somatic components. When cartilage and facial muscle tissues are harmed or completely destroyed due to disease, trauma, or any other degenerative process, homeostasis and basic body functions consequently become negatively affected. Although most cartilage and cells can regenerate themselves after any form of the aforementioned degenerative disease or trauma, the highly specific characteristics of facial muscles and the specific structures of the cells and tissues required for the proper function cannot be exactly replicated by the body itself. Thus, some form of cartilage and bone tissue engineering is necessary for proper regeneration and function. The use of progenitor cells for this purpose would be very beneficial due to their highly adaptable capabilities, as well as their ability to utilize a high diffusion rate, making them ideal for the specific nature and functions of cartilage and facial muscle tissue. Going along with this, once the progenitor cells are obtained, applying them to a scaffold within the oral cavity in the affected location allows them to adapt to the environment and create cartilage or facial muscle tissue that is specific to the form and function of the area. The principal function of the cartilage and tissue is vascularization, which requires a specific form that allows them to aid the proper flow of bodily functions related to the oral cavity such as oxygen flow and removal of waste. Facial muscle is also very thin, making its reproduction much more possible. Taking all these into consideration, this review aims to highlight and expand upon the primary benefits of the cartilage and facial muscle tissue engineering and regeneration, focusing on how these processes are performed outside of and within the body.

Increased expression of chondroitin sulphate proteoglycans in rat hepatocellular carcinoma tissues

AIM:To investigate the expression of chondroitin sulphate proteoglycans(CSPGs)in rat liver tissues of hepatocellular carcinoma(HCC).METHODS:Thirty male Sprague Dawley rats were randomly divided into two groups:control group(n=10) and HCC model group(n=20).Rats in the HCC model groups were intragastrically administrated with 0.2%(w/v)N-diethylnitrosamine(DEN)every 5 d for 16 wk,whereas 0.9%(w/v)normal saline was administered to rats in the control group.After 16 wk from the initiation of experiment,all rats were killed and livers were collected and fixed in 4%(w/v)paraformaldehyde.All tissues were embedded in paraffin and sectioned.Histological staining(hematoxylin and eosin and Toluidine blue)was performed to demonstrate the onset of HCC and the content of sulphated glycosaminoglycan(sGAG).Immunohistochemical staining was performed to investigate the expression of chondroitin sulphate(CS)/dermatan sulphate(DS)-GAG,heparan sulphate(HS)-GAG,keratan sulphate(KS)-GAG in liver tissues.Furthermore,expression and distribution of CSPG family members,including aggrecan,versican,biglycan and decorin in liver tissues,were also immunohistochemically determined.RESULTS:After 16 wk administration of DEN,malignant nodules were observed on the surface of livers from the HCC model group,and their hepatic lobule structures appeared largely disrupted under microscope.Toluidine blue staining demonstrated that there was an significant increase in sGAG content in HCC tissues when compared with that in the normal liver tissues from the control group[0.37±0.05 integrated optical density per stained area(IOD/area)and 0.21± 0.01 IOD/area,P<0.05].Immunohistochemical studies demonstrated that this increased sGAG in HCC tissues was induced by an elevated expression of CS/DS(0.28±0.02 IOD/area and 0.18±0.02 IOD/area,P< 0.05)and HS(0.30±0.03 IOD/area and 0.17±0.02 IOD/area,P<0.01)but not KS GAGs in HCC tissues.Further studies thereby were performed to investigate the expression and distribution of several CSPG components in HCC tissues,including aggrecan,versican,biglycan and decorin.Interestingly,there was a distinct distribution pattern for these CSPG components between HCC tissues and the normal tissues.Positive staining of aggrecan,biglycan and decorin was localized in hepatic membrane and/or pericellular matrix in normal liver tissues;however,their expression was mainly observed in the cytoplasm,cell membranes in hepatoma cells and/or pericellular matrix within HCC tissues.Semi-quantitative analysis indicated that there was a higher level of expression of aggrecan(0.43± 0.01 and 0.35±0.03,P<0.05),biglycan(0.32±0.01 and 0.25±0.01,P<0.001)and decorin(0.29±0.01 and 0.26±0.01,P<0.05)in HCC tissues compared with that in the normal liver tissues.Very weak versican positive staining was observed in hepatocytes near central vein in normal liver tissues;however there was an intensive versican distribution in fibrosis septa between the hepatoma nodules.Semi-quantitative analysis indicated that the positive rate of versican in hepatoma tissues from the HCC model group was much higher than that in the control group(33.61%and 21.28%,P <0.05).There was no positive staining in lumican and keratocan,two major KSPGs,in either normal or HCC liver tissues.CONCLUSION:CSPGs play important roles in the onset and progression of HCC,and may provide potential therapeutic targets and clinical biomarkers for this prevalent tumor in humans.

Osteoporosis as A Source of Tissue Mineralization Research on Osteoporosis Therapy and Dissolution of Arterial Mineralization

Based on research conducted by the author in the last thirty-five years, this article presents the physicochemical mechanisms of the osteoporosis process, transport of substances created as its result, and the phenomena of tissue mineralization resulting from osteoporosis. Examination of bones, joint cartilage, arteries, veins, parts of heart, thyroid, salivary glands, various tumors and others was conducted with the use of biological and polarizing microscopy, SEM, EDS, ASA, IR, Raman spectroscopy, and X-ray diffraction. Several devices of the same kind, e.g. different types of SEM, were used. Specimens used for examination were obtained from post-surgery and post rnortem materials. Examination of human bones focused on their mineralization and demineralization （osteoporosis）. Examination of the mineralization of other tissues was conducted in terms of the ageing of human body. Obtained results show that the process of osteoporosis leads not just to mechanical degradation of bones, but through the transport of ions （mainly Ca and P）, it also causes mineralization of soft tissue. Such mineralization occurs in mineralization centers that have been classified in regard to genetics. Tissue mineralization in its first stage is latent and consists of including atoms, mainly Ca and P, into the biological structures of compounds that build the tissues. Latent mineralization may evolve into the next stage--apparent mineralization. Both types of mineralization cause many health issues and may lead to death. This article also presents initial results of research on dissolution of aortic mineralization.

Repair of articular cartilage defects in rabbits through tissue-engineered cartilage constructed with chitosan hydrogel and chondrocytes

Objective： In our previous work, we prepared a type of chitosan hydrogel with excellent biocompatibility. In this study, tissue-engineered cartilage constructed with this chitosan hydrogel and costal chondrocytes was used to repair the articular cartilage defects. Methods： Chitosan hydrogels were prepared with a crosslinker formed by combining 1,6-diisocyanatohexane and polyethylene glycol. Chitosan hydrogel scaffold was seeded with rabbit chondrocytes that had been cultured for one week in vitro to form the preliminary tissue-engineered cartilage. This preliminary tissue-engineered cartilage was then transplanted into the defective rabbit articular cartilage. There were three treatment groups： the experimental group received preliminary tissue-engineered cartilage; the blank group received pure chitosan hydrogels; and, the control group had received no implantation. The knee joints were harvested at predetermined time. The repaired cartilage was analyzed through gross morphology, histologically and immunohistochemically. The repairs were scored according to the international cartilage repair society （ICRS） standard. Results： The gross morphology results suggested that the defects were repaired completely in the experimental group after twelve weeks. The regenerated tissue connected closely with subchondral bone and the boundary with normal tissue was fuzzy. The cartilage lacuna in the regenerated tissue was similar to normal cartilage lacuna. The results of ICRS gross and histological grading showed that there were significant differences among the three groups （P〈0.05）. Conclusions： Chondrocytes implanted in the scaffold can adhere, proliferate, and secrete extracellular matrix. The novel tissue-engineered cartilage constructed in our research can completely repair the structure of damaged articular cartilage.

4-Axis printing microfibrous tubular scaffold and tracheal cartilage application

Long-segment defects remain a major problem in clinical treatment of tubular tissue reconstruction.The design of tubular scaffold with desired structure and functional properties suitable for tubular tissue regeneration remains a great challenge in regenerative medicine.Here,we present a reliable method to rapidly fabricate tissueengineered tubular scaffold with hierarchical structure via 4-axis printing system.The fabrication process can be adapted to various biomaterials including hydrogels,thermoplastic materials and thermosetting materials.Using polycaprolactone(PCL)as an example,we successfully fabricated the scaffolds with tunable tubular architecture,controllable mesh structure,radial elasticity,good flexibility,and luminal patency.As a preliminary demonstration of the applications of this technology,we prepared a hybrid tubular scaffold via the combination of the 4-axis printed elastic poly(glycerol sebacate)(PGS)bio-spring and electrospun gelatin nanofibers.The scaffolds seeded with chondrocytes formed tubular mature cartilage-like tissue both via in vitro culture and subcutaneous implantation in the nude mouse,which showed great potential for tracheal cartilage reconstruction.

Relationship between triphasic mechanical properties of articular cartilage and osteoarthritic grade

The purpose of this study was to explore the triphasic mechanical properties of osteoarthritic cartilage with different pathological grades.First,samples of cartilage from rabbits with different stages of osteoarthritis (OA) were graded.Following this,the cartilage was strained by a swelling experiment,and changes were measured using a high-frequency ultrasound system.The result,together with fixed charge density and water volume fraction of cartilage samples,was used to estimate the uniaxial modulus of the cartilage tissue,based on a triphasic model.For the control cartilage samples,the uniaxial elastic modulus on the cartilage surface was lower than those in the middle and deep layers.With an increase in the OA grade,the uniaxial elastic modulus of the surface,middle and deep layers decreased.A significant difference was found in the surface elastic modulus of different OA grades (P<0.01),while no significant differences were identified for OA cartilages of Grades 1 and 2 in the middle and deep layers (P<0.01).Compared with Grades 1 and 2,there was a significant reduction in the elastic modulus in the middle and deep layers of Grade 3 OA cartilage (P<0.05).Overall,this study may provide a new quantitative method to evaluate the severity of OA using the mechanical properties of cartilage tissue.

Treatment of subtrochanteric femoral fracture with long proximal femoral nail antirotation

Objective： Subtrochanteric femoral fractures are severe injuries. Although many treatment methods have been developed, controversy exists regarding the optimal management of these fractures. This study evaluated the clinical outcome of subtrochanteric femoral fractures fixed with long proximal femoral nail antirotation （PFNA-Iong）. Methods： Between October 2006 and February 2008, 25 patients with traumatic subtrochanteric fractures of the femur were treated with PFNA-long. Closed reduction and fixation were performed in 20 cases. In the remaining 5 cases, closed reduction was difficult, so limited open reduction was performed, with bone grafting in 4 cases and circumfer-ential wiring in 4 cases. Results： The average follow-up time was 16.1 months. All subtrochanteric femoral fractures healed uneventfully except one case of delayed union. The mean union time was 26.2 weeks. Technical difficulties with nail insertion were encountered in 3 cases. No implant failure was observed. Conclusion： PFNA-long is effective in treatment of subtrochanteric femoral fractures, with a high rate of bone union, minor soft tissue damage, early return to functional exercise and few implant-related complications.

Complications in the management of closed high-energy proximal tibial plateau fractures

Purpose： To report complications in the management of complex closed proximal tibial fractures. Method： A retrospective study was conducted to analyze the infectious and noninfectious complications encountered in the management of high-energy Schatzker type V and VI tibial plateau fractures. All patients were treated at the level 1 trauma centre between January 20tl and March 2014. Sixty two patients were included in the study. The mean patient age was （43.16 ±11.59） years with 60 males and 2 females. Infectious complications like superficial and deep infection, wound dehiscence, malalignment in the immediate postoperative period and in follow-up period were noted. Results： The overall complication rate was 30.65% （19 out of 62）. Infectious complications were noted in 20.97% cases （13162）. In majority of the cases （8113）, superficial infection was seen which managed with regular dressing and antibiotic administration. The patients （5/13） who had developed deep-seated infection were subjected to repeated debridements, flap coverage, implant removal or amputation depending upon the host response. Thirteen patients had experienced noninfectious complications. Hardware related complications were noticed in six patients and four among them received a secondary procedure. Malalignment was observed in seven patients but only single patient underwent subsequent operative intervention. Conclusion： Proximal tibial plateau fractures especially Shatzker type V and VI are associated with extensive soft tissue damage even in closed injuries. The complications encountered in the management of these fractures can be minimized with appropriate patient selection and minimal soft tissue dissection.

Clinical observation of auricular acupoint therapy for pain in early-stage extremity trauma

Objective： To observe the efficacy of auricular acupoint sticking based on conventional treatment in treating pain in early-stage extremity trauma. Methods： A hundred eligible patients with acute soft tissue injury or acute closed fracture were randomized into an observation group and a control group by their admission sequence, 50 cases in each group. The two groups both received routine management including routine checking, external fixing, traction, raising up the affected limb, etc., as well as cold compress with Chinese medication （Xiao Zhong Zhi Tong Powder）. In addition to the routine management, the control group was given oral administration of amidopyrine and phenacetin compound tablet, I tablet per dose, twice a day, which was then taken only when necessary or terminated after pain subsided. The observation group was given auricular acupoint sticking in addition to the routine management. The two groups were compared in terms of numerical rating scale （NRS） score, therapeutic efficacy and adverse reactions after pain was relieved. Results： After the intervention, the NRS scores dropped significantly in both groups （P〈0.01）; the NRS score in the observation group was significantly lower than that in the control group （P〈0.05）. The total effective rate in the observation group was superior to that in the control group （P〈0.05）. There were no severe adverse reactions in the two groups. Conclusion： Based on routine management, auricular acupoint sticking can produce a more significant efficacy in treating pain in early-stage extremity trauma compared to amidopyrine and phenacetin compound tablet; it can effectively reduce pain of the affected limb and prevent complications; it＇s easy-to-operate and safe; patients can learn and understand it easily; its efficacy is confirmed; it enhances the satisfaction degree of the inpatients. Therefore, this method is worth promoting in clinic.

Posterior coronal plating for tibial fractures： technique and advantages

Objective： Tibial shaft fractures are straightforward to treat but when associated with soft tissue injury particularly at the nail entry/plate insertion site or there is significant comminution proximally or a large butterfly fragment/a second split component in the posterior coronal plane, it is a challenge to the treating surgeon. The aim of the present report is to describe the technique of posterior coronal plating in such a scenario and its ad- vantages. Methods： Between July 2008 and June 2011, 12 patients were prospectively treated by this approach using 4.5 mm broad dynamic compression plates. Results： The time of bony consolidation and full weight bearing averaged 21.7 weeks （range, 16-26 weeks）. Patients were followed up for at least 24 months （range, 24-48 months）. At 1 year postoperatively, no loss in reduction or alignment was observed. Mean Hospital for Lower Extremity Measurement Functional Score was 72.8 （range, 64-78）. All patients were satisfied with their treatment outcomes. Conclusion： Direct posterior approach and fixation using prone position helps to visualise the fracture fragments and provide rigid fixation. The approach is simple and extensile easily, apart from advantages of less soft tissue and hardware problems compared to standard medial or lateral plating.

Uninduced adipose-derived stem cells repair the defect of full-thickness hyaline cartilage

Objective： To testify the effect of the stem cells derived from the widely distributed fat tissue on repairing full-thickness hyaline cartilage defects. Methods： Adipose-derived stem cells （ADSCs） were derived from adipose tissue and cultured in vitro. Twenty- seven New Zealand white rabbits were divided into three groups randomly. The cultured ADSCs mixed with calcium alginate gel were used to fill the full-thickness hyaline cartilage defects created at the patellafemoral joint, and the defects repaired with gel or without treatment served as control groups. After 4, 8 and 12 weeks, the reconstructed tissue was evaluated macroscopically and microscopically. Histological analysis and qualitative scoring were also performed to detect the outcome.Results： Full thickness hyaline cartilage defects were repaired completely with ADSCs-derived tissue. The result was better in ADSCs group than the control ones. The microstructure of reconstructed tissue with ADSCs was similar to that of hyaline cartilage and contained more cells and regular matrix fibers, being better than other groups. Plenty of collagen fibers around cells could be seen under transmission electron microscopy. Statistical analysis revealed a significant difference in comparison with other groups at each time point （t=4.360, P〈0.01）. Conclusion： These results indicate that stem cells derived from mature adipose without induction possess the ability to repair cartilage defects

Experiences and lessons about soft-tissue flaps covering of severe open tibial fracture

Objective: To sum up experiences and lessons about management of soft-tissue reconstruction in open tibial fracture over a 6-year period. Methods: Twenty-two flap reconstructions were performed to treat soft-tissue defect of 22 patients with open tibial fracture Type IIIB (Gustilo) from 1993 to 1998. The cases were analyzed and discussed retrospectively after follow up of 12-61 months. Results: The size of the flap ranged from 6.6 cm 2 to 28.18 cm 2 and the rate of flap failure was 13.6%. Besides, 3 partial necrosis and 2 postoperative infections occurred in this series. Conclusions: For soft tissue defect of delayed open tibial fracture Type IIIB, flap reconstruction is still an optimal option. The experiences we obtained are ① to design a triangular skin extension or a small Z-plasty over the pedicle to reduce the flap tension; ② to select a unilateral external fixation to provide convenience for any secondary manipulation; and ③ to use serial debridement to diminish flap failure.

The effects of sodium hyaluronate on mRNA expressions of matrix metalloproteinase-1,-3 and tissue inhibitor of metalloproteinase-1 in cartilage and synovium of traumatic osteoarthritis model

Objective: To observe the influence of intra-articular injection of sodium hyaluronate (HA) on the mRNA expressions of matrix metalloproteinase-1,-3 (MMP-1,-3) and tissue inhibitor of metalloproteinase-1 (TIMP-1) in cartilage and synovium of traumatic osteoarthritis (OA).Methods: Sixteen white rabbits underwent unilateral anterior cruciate ligament transection (ACLT) were divided into 2 groups randomly 5 weeks after transection. The experimental group rabbits received 0.3 ml of 1% HA by intra-articular injection once a week. Animals in the control group were treated under the same conditions using physiological saline. Ten weeks following surgery, cartilage and synovium were harvested. The mRNA expressions of MMP-1, MMP-3 and TIMP-1 were analyzed using reverse transcription-polymerase chain reaction (RT-PCR).Results: In synovium, the mRNA expression of MMP-3 was suppressed in the HA injection group. HA treatment had no effect on the MMP-3 expression in cartilage. No significant difference of MMP-1 and TIMP-1 expressions in cartilage and synovium was found between the HA injection group and the control group.Conclusions: One of the mechanisms of the therapeutic effect of HA may be the inhibition of expression of MMP-3 in synovium during early stage of traumatic OA.