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Background/purpose: Previous reports, mostly small clinical trials conducted in USA or Europe, indicated that tranexamic acid (TXA) would be effective for reducing blood transfusions after total knee arthroplasty (TKA). However, large scale studies are needed regarding the effectiveness and safety issue of complication events following TKA, especially for the Asian population. We aimed to evaluate the efficacy and safety of TXA use based on data from an elderly population in Taiwan.Methods: This was a retrospective population-based study using an inpatient dataset from the nationwide health insurance research database in Taiwan. Patients aged >65 years with a diagnosis of osteoarthritic knee in 2012 were included (n = 10,321). A low-dose intravenous form of TXA (250-1000 mg) was identified perioperatively during the TKA. The surgical outcomes of interest were allogeneic red blood cell transfusion and postoperative 30-day complications.Results: A total of 1205 (11.7%) patients received TXA. Based on a multilevel logistic regression model, we found a 47% odds reduction of blood transfusion without elevating the complications of infection and vascular-related diseases. Furthermore, the drug effect in reducing transfusion was different among hospital levels, and medical centers had a relatively lower transfusion rate.Conclusion: The use of perioperative TXA was an efficient strategy to prevent blood loss after TKA. [ABSTRACT FROM AUTHOR]

Background/purpose: Understanding failure modes, time to revision, and vulnerable components in revision hips could help reduce the risk of revision surgeries. Our aim was to investigate the association between the index diagnosis and the failure mode in patients undergoing revision surgeries.Methods: A total of 402 patients who underwent a first revision surgery in a single hospital between 2000 and 2012 were recruited in a retrospective study. Multiple logistic regression analysis was used to evaluate the association of the index diagnosis of the primary total hip arthroplasty and short-term failure, as well as specific failure mode that occurred early, while controlling for sex, age, and the type of prosthesis.Results: The mean time to revision due to all failure modes was 9.48 (standard deviation = 6.08) years. Defining short-term failure as a time to revision <5 years after total hip arthroplasty, the primary failure mode was infection (32.4%), followed by loosening (25.7%) and instability (17.1%). In multivariate analysis, as compared to osteonecrosis, patients with index diagnosis as infection was significantly associated with revision due to infection (odds ratio = 9.69, p = 0.013). In addition, osteoarthritis increased the odds of loosening (odds ratio = 4.18, p = 0.012). In contrast to studies in the United States and Europe, acetabular component revisions were the most common type found in our study.Conclusion: This study demonstrates that, compared with patients with osteonecrosis, patients with infection and osteoarthritis had higher odds of revision due to infection and loosening, respectively. Further studies are needed to examine the cause-effect relationship between index diagnosis and mode of failure. [ABSTRACT FROM AUTHOR]

Background/purpose: Expansive open-door laminoplasty (EOLP) is a useful technique for multiple-level cervical spondylotic myelopathy. The common postoperative complications of EOLP include moderate to severe neck pain, loss of cervical lordosis, decrease of cervical range of motion, and C5 palsy. We modified the surgical technique to lessen these complications. This study is aimed to elucidate the efficacy of modified techniques to lessen the complications of traditional procedures. Methods: We collected data from 126 consecutive patients treated at our institution between August 2008 and December 2012. Of these, 66 patients underwent conventional EOLP (CEOLP) and the other 60 patients underwent modified EOLP (MEOLP). The demographic and preoperative data, axial pain visual analog scale scores at 2 weeks and 3 months postoperatively, clinical outcomes evaluated using Nurick score and Japanese Orthopedic Association recovery rate at 12 months postoperatively, and radiographic results assessed using plain films at 3 months and 12 months postoperatively for both groups were compared and analyzed. Results: There were no significant differences regarding the preoperative condition between the CEOLP and MEOLP groups (p > 0.05). The Japanese Orthopedic Association recovery rate of the MEOLP group was 70.3%, comparable to the result of the other group (70.2%). Postoperative axial neck pain, loss of range of motion, and loss of lordosis of cervical curvature decreased significantly in the MEOLP group (p < 0.05). The complications of temporary C5 nerve palsy found in the CEOLP group did not exist in the MEOLP group. Conclusion: MEOLP is a minimally invasive surgical method to treat multiple-level cervical spondylotic myelopathy, which decreases postoperative complications effectively. [ABSTRACT FROM AUTHOR]

The microenvironment plays a crucial role in stem cell differentiation, and a scaffold that mimics native cartilaginous extracellular components can promote chondrogenesis. In this study, a collagen–gelatin–hyaluronic acid–chondroitin sulfate tetra-copolymer scaffold with composition and architecture similar to those of hyaline cartilage was fabricated using a microfluidic technique and compared with a pure gelatin scaffold. The newly designed biomimetic scaffold had a swelling ratio of 1278 % ± 270 %, a porosity of 77.68 % ± 11.70 %, a compressive strength of 1005 ± 174 KPa, and showed a good resilience against compression force. Synovium-derived stem cells (SDSCs) seeded into the tetra-copolymer scaffold attached to the scaffold firmly and exhibited good mitochondrial activity, high cell survival with a pronounced glycosaminoglycan production. SDSCs cultured on the tetra-copolymer scaffold with chondrogenic induction exhibited upregulated mRNA expression of COL2A1 , ChM-1 , Nrf2 , TGF-β1 , and BMP-7. Ex vivo study revealed that the SDSC–tetra-copolymer scaffold regenerated cartilage-like tissue in SCID mice with abundant type II collagen and S-100 production. BMP7 and COL2A1 expression in the tetra-copolymer scaffold group was much higher than that in the gelatin scaffold group ex vivo. The tetra-copolymer scaffold thus exhibits strong chondrogenic capability and will facilitate cartilage tissue engineering. • A scaffold that mimics native cartilaginous ECM may facilitate chondrogenesis of stem cells. • Biomimetic tetra-copolymer scaffolds with high porosity and adequate mechanical strength were fabricated. • SDSCs cultured on the tetra-copolymer scaffold upregulated COL2A1 , TGF-β1 , and BMP-7 mRNA expression. • Ex vivo study revealed that the SDSC–tetra-copolymer scaffold regenerated cartilage-like tissue in SCID mice. • The tetra-copolymer scaffold with similar constituents to hyaline cartilage has strong chondrogenic capability. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Erythropoietin (EPO) has pleiotropic cytoprotective actions. We investigated the effects of EPO on the physiopathology and cytokine levels after haemorrhagic shock (HS) in conscious rats. Methods: Rats received an intravenous injection of 300U/kg EPO over 10min followed by HS via withdrawal of 60% of total blood volume from a femoral arterial catheter (6ml/100g body weight) over 30min. Mean arterial pressure (MAP) and heart rate (HR) were monitored continuously for 18h after the start of blood withdrawal. Levels of biochemical parameters, including haemoglobin, GOT, GPT, BUN, creatinine (Cr), LDH, CPK, and lactate were measured at 30min before the induction of HS and 0, 1, 3, 6, 9, 12, and 18h after HS. Cytokine levels, including TNF-α and IL-6, in serum were measured at 1, 9, and 18h after HS. The kidneys, liver, lungs, and small intestine were removed for pathology assessment at 48h after HS. Results: HS significantly increased HR, blood GOT, GPT, BUN, Cr, LDH, CPK, lactate, TNF-α, and IL-6 levels and decreased haemoglobin and MAP in rats. Pre-treatment with EPO improved survival rate, preserved the MAP, decreased the tachycardia and markers of organ injury, suppressed the release of TNF-α and IL-6 after HS in rats. Conclusion: Pre-treatment with EPO suppresses the release of serum TNF-α and IL-6, along with decreasing the levels of markers of organ injury associated with HS, with such actions ameliorating HS-induced organ damage in rats. [Copyright &y& Elsevier]