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Bone & Joint Research
Vol. 11, Issue 6 | Pages 398 - 408
22 Jun 2022
Xu T Zeng Y Yang X Liu G Lv T Yang H Jiang F Chen Y

Aims

We aimed to evaluate the utility of 68Ga-citrate positron emission tomography (PET)/CT in the differentiation of periprosthetic joint infection (PJI) and aseptic loosening (AL), and compare it with 99mTc-methylene bisphosphonates (99mTc-MDP) bone scan.

Methods

We studied 39 patients with suspected PJI or AL. These patients underwent 68Ga-citrate PET/CT, 99mTc-MDP three-phase bone scan and single-photon emission CT (SPECT)/CT. PET/CT was performed at ten minutes and 60 minutes after injection, respectively. Images were evaluated by three nuclear medicine doctors based on: 1) visual analysis of the three methods based on tracer uptake model, and PET images attenuation-corrected with CT and those not attenuation-corrected with CT were analyzed, respectively; and 2) semi-quantitative analysis of PET/CT: maximum standardized uptake value (SUVmax) of lesions, SUVmax of the lesion/SUVmean of the normal bone, and SUVmax of the lesion/SUVmean of the normal muscle. The final diagnosis was based on the clinical and intraoperative findings, and histopathological and microbiological examinations.


Orthopaedic Proceedings
Vol. 102-B, Issue SUPP_6 | Pages 1 - 1
1 Jul 2020
Xiong L Hu Y Ding F Shao Z Wang W Liu G Cai X
Full Access

The purpose of this study was to evaluate whether AGEs induce annulus fibrosus (AF) cell apoptosis and to further explore the mechanism by which this process occurs.

AF cells were treated with various concentrations of AGEs for 3 days. Cell proliferation was measured by the Cell Counting Kit-8 (CCK-8) and EdU incorporation assays. Cell apoptosis was examined by the Annexin V/PI apoptosis detection kit and Hoechst 33342. The expression of apoptosis-related proteins, including Bax, Bcl-2, cytochrome c, caspase-3 and caspase-9, was detected by western blotting. In addition, Bax and Bcl-2 mRNA expression levels were detected by RT-PCR. Mitochondrial membrane potential (MMP) and intracellular reactive oxygen species (ROS) production of AF cell were examined by JC-1 staining and DCFH-DA fluorescent probes, respectively.

Our results indicated that AGEs had inhibitory effects on AF cell proliferation and induced AF cell apoptosis. The molecular data showed that AGEs significantly up-regulated Bax expression and inhibited Bcl-2 expression. In addition, AGEs increased the release of cytochrome c into the cytosol and enhanced caspase-9 and caspase-3 activation. Moreover, treatment with AGEs resulted in a decrease in MMP and the accumulation of intracellular ROS in AF cells. The antioxidant N-acetyl-L-cysteine significantly reversed AGE-induced MMP decrease and AF cell apoptosis.

These results suggest that AGEs induce rabbit AF cell apoptosis and mitochondrial pathways may be involved in AGE-mediated cell apoptosis, which may provide a theoretical basis for diabetic IVD degeneration.


Orthopaedic Proceedings
Vol. 96-B, Issue SUPP_11 | Pages 296 - 296
1 Jul 2014
Liu G Tan B Riew D Wong H
Full Access

Summary Statement

Tandem stenosis is a prevalent condition in an Asian population with the narrowest cervical canal diameters and risk factors include advanced age and increased levels of lumbar canal stenosis.

Introduction

Tandem spinal stenosis (TSS) is defined as patient with concomitant spinal canal stenosis found in both cervical (C) and lumbar (L) spinal region. Few studies have reported the incidence of TSS is ranged from 5–25%, but these are all noncomparative, small cohort studies. To the best of author knowledge this is the 1st study aims to compare the prevalence of TSS and its risk factors of development in a large multiracial Asian population.


Orthopaedic Proceedings
Vol. 96-B, Issue SUPP_11 | Pages 312 - 312
1 Jul 2014
Malhotra R Kumar N Wu P Zaw A Liu G Thambiah J Wong H
Full Access

Summary

Metastatic spinal disease is a common entity of much debate in terms of ideal surgical treatment. The introduction of MIS can be a game-changer in the treatment of MSD due to less peri-operative morbidity and allowing earlier radiotherapy and/or chemotherapy.

Introduction

Less invasive techniques have always been welcome for management of patients with ‘Metastatic Spinal Disorders’. This is because these patients can be poor candidates for extensive / major invasive surgery even though radiologically, there may be an indication for one. The aim of the treatment with Minimal Invasive Fixation (MIS) systems is mainly for ‘pain relief’ than to radically decrease tumour burden or to achieve near total spinal cord decompression, which could be major presentations in these patients. These procedures address the ‘spinal instability’ very well and they can address pain associated with compression fractures resulting from metastatic disease from a solid organ as well as multiple myeloma with minimal complications. These procedures can be combined with radiology and chemotherapy without much concern for wound problems in the way of infection or dehiscence. They also have a great advantage of timing of adjunct therapy closer to the index procedure. The disadvantage, however, are they do not allow thorough decompression of the spinal cord. There could also be problem in addressing patients who have severe vertebral height loss or loss of integrity of the anterior column where anterior column reconstruction may be required. There is a risk of inadequate fixation or implant loosening or failure. We aim to examine the results of MIS surgery in our department and support the rationale for its use.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_IV | Pages 496 - 497
1 Oct 2010
Chin TL Liu G Shen L Hee KW
Full Access

Introduction: Fractures are common with well described morbidities. Few small studies have reported in-hospital mortality of patients with fractures. This study aims to describe the distribution of fractures, the incidence of in-hospital fracture mortality and its risk factors.

Materials and Methods: All patients with fractures related to the hip, pelvis, femur, tibia and spine over a 10 year period in a university hospital were identified using the ICD-9 codes upon discharge. Age, gender, race, length of hospital stay and in-hospital mortality data were collected from electronic records. Detailed analysis of the mortality data was performed with statistical analysis using SPSS software.

Results: 8709 fractures were identified, of which 30.3% were hip fractures [1422(54%) NOF and 1216(46%) IT fractures], 24.4% were spinal fractures [144 (7%) cervical; 558(26%) thoracic; 1038(49%) lumbar; 47(2.2%) sacral and 335(16%) unclassified spine fractures], 24.1% were tibial fractures [proximal and shaft], 14.4% were femoral fractures [1037(83%) shaft and 215(17%) supracondylar] and 6.9% were pelvic fractures [265(42%) non rami and 351(58%) rami fractures]. 25% of the fractures occurred between age 21–40 years and 65% fractures occurred in patients older than age 41 years. 53% of the patients were male. 69%, 12% and 11% of the fractures were found in Chinese, Malay and Indian respectively. 90% were closed fractures.

Overall in-hospital fracture mortality was 1.3% (117 fractures). Fracture specific in-hospital mortality was 2.8% (75 fractures) for hip fractures, 5% (13) for non rami pelvic fractures, 1% (20) for spinal fractures, 0.5% (6) for femoral fractures and near 0%(1) for tibial fractures. In-hospital mortality increased with age (0.4% mortality between 21–40 years, 0.6% between 41–60 years, 0.9% between 61–70 years, 1.7% between 71–80 and 4% between 81–90 years). Infection related causes of death were most common. The mean duration from hospital admission until death was 19 days (SD 20, range 1–34). More hip and spine fractures were seen in Chinese and more femoral and tibial fractures were seen in Malay and Indian patients, and this difference was statistically significant. Logistic regression analysis showed only increased patient age, male gender and fracture type as statistically significant risk factors for increased in-hospital mortality. Subgroup analysis showed a 30 and 20 times increased risk of in-hospital mortality for pelvic (p=0.001, 95% CI 4, 241) and hip (p=0.003, 95% CI 3, 159) fractures respectively.

Conclusion: The overall in-hospital fracture mortality was 1.3% (2.8 % for hip and 5% for pelvic fractures). Increased patient age, male gender, hip and pelvic fractures were found to be risk factors for increased mortality.