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Fan Y.,Shanghai JiaoTong University | Wang J.,Shanghai Institute of Traumatology and Orthopaedics | Wei L.,Shanghai Institute of Traumatology and Orthopaedics | He B.,Shanghai JiaoTong University | And 2 more authors.
International Journal of Cardiology | Year: 2011

Background/objectives: Major bleeding in patients with acute coronary syndrome (ACS) increases the risk of recurrent ACS and mortality. However, the mechanism involved is poorly understood. Bleeding induces iron deficiency. Iron deficiency enhances inflammation in other diseases. Thus, in this paper, the particular effect of iron deficiency on atherosclerotic plaque destabilization, especially the pro-inflammatory role of iron deficiency in atheroma and the mechanism involved were investigated. Methods: Extracellular matrix metalloproteinase inducer (EMMPRIN) and matrix metalloproteinase-9 (MMP-9) mRNA levels were investigated by RT-PCR. EMMPRIN and MMP-9 protein levels, nuclear factor (NF)-κB-p65 protein levels, peroxisome proliferator-activated receptor γ (PPARγ) protein levels, and mitogen-activated protein kinase (MAPK) phosphorylation were determined by western blotting. MMP-9 enzymatic activity was assayed by gelatin zymography. Results: Iron deficiency enhanced EMMPRIN, MMP-9 production, and MMP-9 enzymatic activity in THP-1 derived macrophages and foam cells. Iron deficiency elicited the activation of NF-κB and p38 MAPK. By using the p38 inhibitor and NF-κB inhibitor, the study established that EMMPRIN and MMP-9 inductions by iron deficiency required the consecutive upstream activation of p38 MAPK and NF-κB. This pro-inflammatory action was not prevented by PPARγ agonist. Meanwhile, iron deficiency did not modulate PPARγ expression. Retinoid X receptor agonist suppressed the effects of iron deficiency on EMMPRIN, MMP-9, and NF-κB, but not on MAPK activation. Conclusions: Iron deficiency enhances atheroma inflammation through p38 MAPK-NF-κB-EMMPRIN/MMP-9 pathway. Our findings provide a potential mechanism for the association of major bleeding with recurrent ACS and mortality in patients with ACS. © 2010 Elsevier Ireland Ltd. All rights reserved.


Wang B.,Shanghai Institute of Traumatology and Orthopaedics | Wang B.,Shanghai JiaoTong University | Wang B.,University of Utah | Saltzman C.L.,University of Utah | And 2 more authors.
Clinical Orthopaedics and Related Research | Year: 2015

Questions/purposes: In this study we sought to (1) compare ankle and hindfoot alignment of our study cohort with end-stage ankle arthritis with that of a control group; (2) explore the frequency of compensated malalignment between the tibiotalar and subtalar joints in our study cohort; and (3) assess the intraobserver and interobserver reliability of classification methods of hindfoot alignment used in this study.Background: Patients with ankle arthritis often present with concomitant hindfoot deformity, which may involve the tibiotalar and subtalar joints. However, the possible compensatory mechanisms of these two mechanically linked joints are not well known.Methods: Between March 2006 and September 2013, we performed 419 ankle arthrodesis and ankle replacements (380 patients). In this study, we evaluated radiographs for 233 (56%) ankles (226 patients) which met the following inclusion criteria: (1) no prior subtalar arthrodesis; (2) no previously failed total ankle replacement or ankle arthrodesis; (3) with complete conventional radiographs (all three ankle views were required: mortise, lateral, and hindfoot alignment view). Ankle and hindfoot alignment was assessed by measurement of the medial distal tibial angle, tibial talar surface angle, talar tilting angle, tibiocalcaneal axis angle, and moment arm of calcaneus. The obtained values were compared with those observed in the control group of 60 ankles from 60 people. Only those without obvious degenerative changes of the tibiotalar and subtalar joints and without previous surgeries of the ankle or hindfoot were included in the control group. Demographic data for the patients with arthritis and the control group were comparable (sex, p = 0.321; age, p = 0.087). The frequency of compensated malalignment between the tibiotalar and subtalar joints, defined as tibiocalcaneal angle or moment arm of the calcaneus being greater or smaller than the same 95% CI statistical cutoffs from the control group, was tallied. All ankle radiographs were independently measured by two observers to determine the interobserver reliability. One of the observers evaluated all images twice to determine the intraobserver reliability.Results: There were differences in medial distal tibial surface angle (86.6° ± 7.3° [95% CI, 66.3°–123.7°) versus 89.1° ± 2.9° [95% CI, 83.0°–96.3°], p < 0.001), tibiotalar surface angle (84.9° ± 14.4° [95% CI, 45.3°–122.7°] versus 89.1° ± 2.9° [95% CI, 83.0°–96.3°], p < 0.001), talar tilting angle (−1.7° ± 12.5° [95% CI, −41.3°–30.3°) versus 0.0° ± 0.0° [95% CI, 0.0°–0.0°], p = 0.003), and tibiocalcaneal axis angle (−7.2° ± 13.1° [95% CI, −57°–33°) versus −2.7° ± 5.2° [95% CI, −13.3°–9.0°], p < 0.001) between patients with ankle arthritis and the control group. Using the classification system based on the tibiocalcaneal angle, there were 62 (53%) and 22 (39%) compensated ankles in the varus and valgus groups, respectively. Using the classification system based on the moment arm of the calcaneus, there were 68 (58%) and 20 (35%) compensated ankles in the varus and valgus groups, respectively. For all conditions or methods of measurement, patients with no or mild degenerative change of the subtalar joint have a greater likelihood of compensating coronal plane deformity of the ankle with arthritis (p < 0.001–p = 0.032). The interobserver and intraobserver reliability for all radiographic measurements was good to excellent (the correlation coefficients range from 0.820 to 0.943).Conclusions: Substantial ankle malalignment, mostly varus deformity, is common in ankles with end-stage osteoarthritis. The subtalar joint often compensates for the malaligned ankle in static weightbearing.Level of Evidence: Level III, diagnostic study. © 2014, The Association of Bone and Joint Surgeons®.


Rong K.,Shanghai Institute of Traumatology and Orthopaedics | Rong K.,Shanghai JiaoTong University | Ge W.-T.,Shanghai Institute of Traumatology and Orthopaedics | Ge W.-T.,Shanghai JiaoTong University | And 4 more authors.
Foot and Ankle International | Year: 2015

Background: Intramuscular lengthening of the gastrocnemius and/or soleus (Baumann procedure) is widely used in patients who have cerebral palsy, with several advantages over other lengthening techniques. Tightness of the gastrocnemius or gastrocnemius-soleus complex has been confirmed to be related to flatfoot deformity. The purpose of this study was to evaluate the mid-term results of the Baumann procedure as a part of the treatment of flatfoot with equinus deformity. Methods: We reviewed 35 pediatric and adult patients (43 feet) with flatfoot who underwent the Baumann procedure for the concomitant equinus deformity. The mean duration of follow-up was 39.4 months. Preoperative and follow-up evaluations included the maximal angle of dorsiflexion of the ankle with the knee fully extended and with the knee flexed to 90 degrees, the American Orthopaedic Foot & Ankle Society ankle-hindfoot (AOFAS-AH) scores, and postoperative complications. Results: Preoperatively, the mean angle of passive ankle dorsiflexion with the knee extended was -4.7 ± 2.7 degrees and that with the knee flexed was 2.3 ± 2.5 degrees. At the final follow-up, both values improved significantly by a mean of 13.6 degrees (P <.001) and 9.7 degrees (P <.001), respectively. The average AOFAS-AH scores improved from 56.8 points preoperatively to 72.1 at the final follow-up. Recurrence of equinus was observed in 3 patients (4 feet). There were no cases of overcorrection, neurovascular injury, or healing problems. Conclusions: Our results indicate that the Baumann procedure can effectively and sequentially correct the tightness of the gastrocnemius or the gastrocnemius-soleus complex in patients with flatfoot deformity, without obvious postoperative complications. © American Orthopaedic Foot & Ankle Society.


Wang B.,Shanghai Institute of Traumatology and Orthopaedics | Wang B.,Shanghai JiaoTong University | Xu X.-Y.,Shanghai JiaoTong University
Foot and Ankle International | Year: 2013

Background: Multiple techniques have been described for reconstruction of the lateral ligaments of the ankle. Most require extensive exposure and dissection, which may lead to potential problems with wound healing, higher risk of nerve injury, fibrosis, and stiffness. This study reports on the results of a minimally invasive method to reconstruct the ligaments using a semitendinosus tendon autograft and achieve a stable ankle while avoiding these problems. Materials and Methods: From September 2006 to May 2010, 25 patients (14 males, 11 females) with chronic ankle instability underwent lateral ligament reconstruction. The average age was 32.4 (range, 17 to 62) years old. A semitendinosus autograft was harvested through 2 small knee incisions. For the ankle reconstruction, 4 small incisions of 5 mm each were made at the medial and lateral side of the fibular tip, the talar neck, and the middle of the calcaneus. Anatomical reconstruction of the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) was then performed through these small incisions. The mean final follow-up was 32.3 (range, 12 to 56) months. AOFAS questionnaires were used to measure clinical outcomes and donor site morbidity and patient satisfaction are also reported. Preoperative and postoperative stress tests were performed and radiographic parameters were measured. Results: The mean AOFAS score increased on average from 71.1 to 95.1 (P <.001). Tw o patients reported residual instability on uneven ground. No patient reported weakness or disability from the donor site. The satisfaction level was excellent in 20 patients and good in 5 patients. Significant improvement in stress radiographic parameters was noted for the talar tilt angle, with reduction from a mean of 14.0 to 3.8 degrees (P <.001); anterior talar displacement reduced from a mean of 12.3 to 4.6 mm (P <.001). Conclusion: Reconstruction of the lateral ankle ligaments using a semitendinosus tendon autograft and a minimally invasive approach can achieve a stable ankle while avoiding extensive exposure and risk of nerve injury. Level of Evidence: Level I V, retrospective case series. © The Author(s) 2013.


Zhang W.,Shanghai JiaoTong University | Zhang W.,Shanghai Institute of Traumatology and Orthopaedics | Pan W.,Xi'an Physical Education University | Zhang M.,Xi'an Physical Education University | And 3 more authors.
Biotechnology Letters | Year: 2011

Fibrin glue combined with bone morphogenetic protein (BMP) and recombined bone xenograft (RBX), were compared to evaluate their effect on the tendon-bone interface healing. The interface of fibrin glue-BMP developed new cartilage but the new bone was thinner whereas the interface of RBX had large areas of chondrocyte-like cells, bone formation and an immature neo-enthesis structure. At 12 weeks, bone mineral density of RBX group (152 ± 52 cm3) and fibrin glue-BMP group (109 ± 13 cm3) was calculated by micro-computed tomography. The ultimate load of fibrin glue-BMP group (60 ± 18 and 51 ± 14 N) and RBX group (65 ± 21 and 57 ± 15 N) was shown by biomechanics at 6 and 12 weeks. RBX thus has an advantage on accelerating tendon-bone interface healing. © 2010 Springer Science+Business Media B.V.


He C.,Shanghai JiaoTong University | He C.,Shanghai Institute of Traumatology and Orthopaedics | Feng J.-M.,Shanghai JiaoTong University | Yang Q.-M.,Shanghai JiaoTong University | And 3 more authors.
Journal of Surgical Research | Year: 2010

Background: Controversy exists over whether to remove well-fixed components at the time of revision of a failed total hip arthroplasty (THA). The purpose of this study was to evaluate the results of selective acetabular revision after acetabular failure in which only the failed component was replaced. Materials and Methods: Thirty-six isolated acetabular component revisions were performed and prospectively followed for a mean of 4.7 y (range, 2-9.3 y). The components had been in place for a mean of 10.8 y. All femoral components and some metal-backed acetabular shells were well fixed at the time of revision and left in place. Surgery involved cementation of an acetabular liner into a well-fixed acetabular shell in 16 cases, and acetabular revision in 20 cases. Morselized cancellous allograft was used to fill acetabular defects in 27 hips, and proximal femoral defects in 17 hips. Bulk allografts were used to reconstruct the proximal femur in two hips. Results: The mean Harris hip score improved from 57.8 preoperatively to 89.1 at the final follow-up visit. The results were rated excellent in 24 patients, good in nine patients, and fair in three patients. The unrevised femoral components and acetabular shells remained well fixed, and final follow-up radiographs revealed no cases of osteolytic lesion progression around the femoral and acetabular components. Conclusions: Revision of only the failed acetabular component is recommended in cases of isolated acetabular failure, providing excellent results over the medium term, and allowing preservation of bone stock with lower surgical morbidity. © 2010 Elsevier Inc. All rights reserved.


PubMed | Shanghai JiaoTong University and Shanghai Institute of Traumatology and Orthopaedics
Type: | Journal: International orthopaedics | Year: 2016

The aim of the present study was to investigate the long-term outcome and the wear characteristics of two distinct types of ultra-high molecular weight polyethylene (UHMWPE) liners in total hip arthroplasty (THA).We conducted a retrospective clinical study on patients which were treated with total hip arthroplasty using either Enduron polyethylene (Enduron PE) or Trilogy polyethylene (Trilogy PE) liners based on a minimum of ten year follow up data. Morphological analyses of wear particles from tissue samples, which were harvested during revision surgeries, were also performed.A total of 79 THAs in the Enduron group and 55 THAs in the Trilogy group were available for analysis. Kaplan-Meier survival with revision for wear-related complications as the endpoint of the Enduron PE liners was lower than that of Trilogy PE liners at tenyears (93.5% and 100%, P=0.03). The Enduron group had higher mean linear wear rate than that of the Trilogy group (0.200.09 and 0.090.03mm/year, P<0.01). The incidence of osteolysis for the Enduron group was higher than that of the Trilogy group (33.3% and 12%, P=0.04). Under transmission electron microscopy, the Enduron group had more than 82% of the particles less than 1.0m in size and more than 57% of the particles less than 0.5m.The long-term performance of Enduron liners was worse than that of Trilogy liners. Further clinical follow-up may be necessary in patients with Enduron PE liners in order to avoid catastrophic complications.


PubMed | Temple University, Shanghai JiaoTong University and Shanghai Institute of Traumatology and Orthopaedics
Type: | Journal: Scientific reports | Year: 2015

Mller cells are principal glial cells in rat retina and have attracted much attention in glaucoma studies. However, it is not clear whether adenosine and adenosine receptor (AR) antagonists play any roles in the regulation of potassium channels in Mller cells and subsequently in the promotion of glutamine synthetase (GS) and L-Glutamate/L-Aspartate Transporter (GLAST) functions. We found that chronic ocular hypertension (COH) in rat down-regulated Mller cells Kir2.1, Kir4.1, TASK-1, GS and GLAST expressions and attenuated the peak of inward potassium current. Retinal ganglion cells (RGC) count was lower in the COH rats than that in the sham operation animals. Intravitreal injection of selective A2A AR antagonist SCH442416 up-regulated Mller cell Kir4.1, TASK-1, GS and GLAST expressions and enhanced inward potassium currents compared with those in the COH rats with vehicle control. Meanwhile, the RGC count was higher following intravitreal injection of SCH442416 in the COH rats than that after vehicle injection. The fact that PKA inhibitor H-89 blocked these SCH442416 effects suggested that the PKA signaling pathway was involved in the observed ocular responses following the intravitreal SCH442416 injection.


Li H.-Y.,Fudan University | Hua Y.-H.,Fudan University | Wu Z.-Y.,Fudan University | Chen B.,Shanghai Institute of Traumatology and Orthopaedics | Chen S.-Y.,Fudan University
Arthroscopy - Journal of Arthroscopic and Related Surgery | Year: 2013

Purpose The purpose of this study was to compare the biomechanical characteristics of fixation with 2-suture anchors versus transosseous tunnel fixation in anatomic reconstruction of the ankle lateral ligaments. Methods Six matched pairs of human cadaveric ankles underwent anatomic lateral ankle reconstruction, and fixation of the graft on the talus was achieved with 2 suture anchors or a transosseous tunnel. Ankles for the transosseous tunnel group were chosen at random, with the paired contralateral ankles used for the 2-suture anchor group. Half of the peroneus brevis tendon was harvested as a graft. For each technique, one end of the tendon was secured to the original insertion point of the anterior talofibular ligament (ATFL) at the talus, whereas the other end was armed with 2 No. 5 nonabsorbable sutures (Ethicon, Somerville, NJ) and passed through the bone tunnel in the fibula. Biomechanical testing was performed by applying the force in line with the graft. Load to failure was determined at a displacement rate of 50 mm/min. The load-displacement curve, maximum load at failure (N), and stiffness (N/mm) were recorded and compared between the 2 techniques. Results There was no difference between constructs in the 2-suture anchor group and the transosseous tunnel group in terms of the ultimate load and stiffness (161.8 ± 47.6 N v 171.9 ± 76.0 N; P =.92; 4.59 ± 1.85 N/mm v 5.77 ± 1.98 N/mm; P =.35). Most constructs failed because of anchor pullout in the 2-suture anchor group (5 of 6) and fracture of the bony bridge in the transosseous tunnel group (6 of 6). Conclusions The strength of fixation with suture anchors in anatomic reconstruction of the ankle lateral ligaments was equivalent to transosseous tunnel fixation as determined with biomechanical testing. However, this study did not prove that one is advantageous over the other. Clinical Relevance Both techniques showed excellent biomechanical results. Therefore, the 2-suture anchor fixation approach can be safely used in anatomic reconstruction of the ankle lateral ligaments. © 2013 The Arthroscopy Association of North America. Published by Elsevier Inc. All Rights Reserved.


PubMed | Shanghai Institute of Traumatology and Orthopaedics
Type: Comparative Study | Journal: International orthopaedics | Year: 2016

Many surgical techniques for isolated gastrocnemius recession have been described. The purpose of the present study is to compare their therapeutic efficacy and intrinsic stability on a fresh cadaveric model of gastrocnemius tightness.The cadaveric model was established by distracting the knee with spacers composed of low-temperature thermoplastic material, and was identified by the Silfverskild test. Procedures of gastrocnemius recession described by Barouk, Baumann and Strayer were performed. The lengthening distance and improvement of ankle dorsiflexion were measured.The mean ankle angle of the cadaveric models was -15.4 with the knee fully extended, and 8.4 with the knee flexed. The increased angle achieved by the Strayer procedure was significantly greater than that achieved by the Barouk procedure and the Baumann procedure with one cut (P<0.05), but similar to that of the Baumann procedure with two cuts (P>0.05). Compared with the intramuscular lengthening of the gastrocnemius (Baumann and Barouk procedures), the stability of the lengthening after the Strayer procedure was the lowest.The three techniques of isolated gastrocnemius recession have different efficacy and stability in cadaver trials, depending on their own anatomical characteristics. Our study supplies an anatomical guide for the selection of a proper procedure.

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