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Biomedical subjects

C H Shih

Publications and source records attributed to C H Shih.

At least 19 recordsLinked to original sources

Signal transduction pathways and apoptosis in bacteria infected chondrocytes.

The mechanism underlying chronic destructive arthropathy after pyogenic arthritis is not clear. This study evaluated the role of apoptosis in Staphylococcus aureus infected human articular chondrocytes and investigated the signal transduction pathways activated by bacterial infection. Chondrocytes cultured in monolayer were challenged with bacteria for 6 h and were analyzed after incubation for 2, 18, and 24 h. Chondrocytes showed morphologic and biochemical evidences of apoptosis after infection and the following incubation period. Although treatment with extensive washing and vancomycin could ameliorate the amount of apoptosis from 31% to 15% at 2 h, from 48% to 23% at 18 h, and from 58% to 33% at 24 h, the infected samples with treatment still had higher amount of apoptosis than the un-infected controls (ANOVA P < 0.001). Accompanying with the increasing amount of apoptosis, the caspase activity was upregulated in bacteria infected samples and remained high in samples with treatment (ANOVA P < 0.05). Signal transduction pathways activated by bacterial infection were assessed by co-transfection technique. After infection, the c-Jun N-terminal kinase, extracellular signal-regulated kinase, and cyclic AMP-dependent protein kinase activities were elevated by 7.6-, 7.3-, and 3.2-fold, respectively, compared to the uninfected controls. The data support the hypothesis that human chondrocytes will undergo apoptosis after infection by a single organism. Apoptosis and activated intracellular kinase activities may be related to the pathogenesis of post-infectious destructive arthropathy.

Apoptosis↗

Hepatitis C virus infection among teenagers in an endemic township in Taiwan: epidemiological and clinical follow-up studies.

The aim of the study was to elucidate the epidemiological features of Hepatitis C virus (HCV) infection among teenagers in an endemic area by conducting a mass screening study. We also investigated the clinical outcome of the anti-HCV-positive subjects by conducting subsequent short-term and long-term follow-up studies. All 2837 students of two junior middle schools in Tzukuan, aged 13-16 years, were invited to be screened for anti-HCV, HBsAg, AST and ALT in October 1995. A total of 2726 (96%) students responded. Anti-HCV, HCV RNA and aminotransferase levels were evaluated among anti-HCV-positive students 1 month and 30 months later, respectively. A total of 38 (1.4%; M/F = 22/16) participants were anti-HCV-positive. The anti-HCV-positive students had higher rates of exposures to transfusion, anti-HCV-positive families and surgery. The prevalence (2.8%) of the 7 maritime villages was markedly higher than that (0.7%) of the other 8 villages (P < 0.001). Subsequent follow-up studies demonstrated that there might be 5 cases of acute or recent HCV infection, and 6 cases who had recovered from chronic HCV infection.

Adolescent↗

Lateral collateral ligament reconstruction using quadriceps tendon-patellar bone autograft with bioscrew fixation.

The lateral collateral ligament is the primary stabilizer against varus stress and is also an important contributor in maintaining posterolateral knee stability. Quadriceps tendon-patellar bone autograft has been used for anterior or posterior cruciate ligament reconstruction. We introduce a reconstructive procedure to restore the lateral collateral ligament using a quadriceps tendon-patellar bone autograft. The procedure is designed for unstable knees with concomitant cruciate ligament tear and posterolateral complex injury. This is a reasonable choice especially when allograft tissue is not available or in patients who are not suited for the use of bone-patellar tendon-bone autograft.

Arthroscopy↗

Primary cultures of human chondrocytes are susceptible to low inocula of Staphylococcus aureus infection and undergo apoptosis.

Hypocellularity after joint infection has been attributed to the cytotoxic effects of pus, which can cause necrosis of chondrocytes. In this study, primary cultures of human chondrocytes lost their viability and underwent necrosis rapidly with high inocula of Staphylococcus aureus infection. Chondrocytes were shown to undergo apoptosis with low inocula of Staphylococcus aureus or their culture ultrafiltrate. These findings further support the hypothesis that residual bacterial toxins or triggered apoptotic processes in chondrocytes participate in the pathogenesis of post-infectious arthropathy.

Apoptosis↗

Effects of Tamm-Horsfall protein and albumin on calcium oxalate crystallization and importance of sialic acids.

BACKGROUND: Tamm-Horsfall protein and human serum albumin are common urinary proteins that show uncertain inhibitory action on the crystallization of calcium oxalate monohydrate. MATERIALS AND METHODS: Batch experiments on crystal nucleation, growth, and aggregation were performed using purified Tamm-Horsfall protein and albumin before and after enzymatic removal of sialic acids from the proteins. RESULTS: At a concentration of 100 nM, both Tamm-Horsfall protein and albumin promoted the time of crystal nucleation by 18.4% and 8.9%, respectively, relative to the control. However, both of the proteins exerted an inhibitory effect on crystal growth, with the IC(50) being 7.27 nM for Tamm-Horsfall protein and 37.5 nM for albumin. The inhibition of crystal aggregation was 81.82% by Tamm-Horsfall protein 100 nM but only 54.55% at 50 nM after enzymatic removal of the sialic acid. Instead of increasing the inhibition, the effect was changed to promotion after an increase in the concentration of Tamm-Horsfall protein to more than 500 nM for native protein and to more than 100 nM for the enzymatic digest. Albumin showed little change after enzymatic treatment and maintained a maximal inhibitory effect of 72.73% on crystal aggregation when the concentration reached to 100 nM. CONCLUSION: Because the promotion of nucleation could lessen the subsequent saturation of a calcium oxalate solution, it is concluded that Tamm-Horsfall protein and albumin show an overall effect of inhibition on crystallization in vitro. The inhibitory effect of Tamm-Horsfall protein is partly related to sialic acid.

Albumins↗

Tension-band technique for ankle fusion.

A prospective study was conducted to develop a better technique for ankle fusion. Eleven consecutive patients were treated using the tension-band technique for ankle fusion and underwent follow-up for a minimum of 2 years (range: 2-5 years). All 11 patients achieved solid fusion for a fusion rate of 100%. Average time to fusion was 3 months (range: 2-6 months). The indication for ankle fusion was intractable aching pain that could not be controlled by conservative methods. Two of 11 patients underwent surgery due to infected arthritis. After ankle fusion, there was no recurrence of infection during a 3-year follow-up period. The technique included osteotomy of the bimalleoli from the inside out, removal of articular cartilage and preserving wedge space for cancellous bone grafting, with or without staple stabilization, and external immobilization supplementation. The functional outcome in all 11 patients improved from unsatisfactory preoperatively to satisfactory at latest follow-up (P<.001). No significant complications were noted. This simple technique proved excellent for ankle fusion with a satisfactory outcome and is recommended for treating severe ankle arthropathies.

Adult↗

Surgical treatment for pathological long bone fracture in patients with multiple myeloma: a retrospective analysis of 22 cases.

BACKGROUND: The purpose of this study was to retrospectively review the cases of pathologic long bone fractures caused by multiple myeloma treated in our hospital, to analyze the surgical method, complications, radiation therapy, survival time, and influence on quality of life. METHODS: In a retrospective study, 22 patients with the pathological long bone fractures due to multiple myeloma who were surgically treated between 1987 and 1997 were analyzed. All patients received open reduction and internal fixation either with plates or intra-medullary nailing. Cement augmentations were performed in the majority of cases (91%). A detailed retrospective analysis was done to correlate the surgical methods, radiation therapy, functional results, and complications post-surgically. RESULTS: The most common site of fracture was the femur. The mean postoperative survival time was around 19 months. Post-operative pain relief was satisfactory, and only two patients required narcotics. No major complications were observed. However the union rate was only 30%, which might have been due to the inhibitory effect of radiation therapy on bone healing, or insufficient osteogentic ability of the myeloma-involved bone. CONCLUSION: Satisfactory pain relief and low implant failure rate was achieved and no definite evidence of tumor dissemination was found in this study. The authors suggest that open reduction and internal fixation with cement augmentation is a favorable treatment option for those patients suitable for surgery. However, postoperative radiation therapy may be associated with a low rate of union.

Aged↗

Anterior reconstructive spinal surgery with Zielke instrumentation for metastatic malignancies of the spine.

From March 1984 to April 1996, 60 consecutive patients with spinal metastasis underwent palliative surgery by anterior corpectomy and Zielke instrumentation. Their ages ranged from 21 to 76 years (mean 54 years). Thirty-two patients had metastasis to the thoracic spine, 20 to the lumbar spine, and 8 had both thoracic and lumbar metastases. The primary malignancies were lung cancer in 12 patients, colorectal cancer in 10, hepatoma in 9, thyroid cancer in 7, breast cancer in 3, and cancers of the stomach, kidney, nasopharynx, long bones, skin, and cervix in 1 patient each. A primary carcinoma was never identified in 13 patients. In the present series, 4 patients died within 1 month, and 56 patients were followed-up. All maintained spinal stability postoperatively. Forty of 52 patients with severe pain obtained significant symptomatic relief for 3 months or more, and 33 of the 46 paralyzed patients gained neural improvement. Sphincter dysfunction became better in 10 patients, and none became worse. We conclude that anterior corpectomy to decompress neural encroachment with instrumental reconstruction to stabilize the collapsed spine is a good adjunctive treatment in these highly selected patients.

Adult↗

Destructive spondyloarthropathy mimicking spondylitis in long-term hemodialysis patients.

A 63-year-old man with end-stage renal disease (ESRD) who had been undergoing hemodialysis for 18 years suffered persistent neck pain, progressive quadriparesis, and a deteriorating ataxic gait during the 6 months before admission. A sudden onset of aggravating quadriparesis and an inability to ambulate occurred during his trip to Sydney, Australia, 1 week before this admission. Vertebral tuberculosis osteomyelitis of the C5/6 segment was considered and treated in a hospital there. Findings from cervical magnetic resonance imaging (MRI; low signal intensity on both T1- and T2-weighted images) were diagnostic of destructive spondyloarthropathy (DSA) and distinguishable from spinal osteomyelitis preoperatively. Amyloid masses, mainly composed of B-2 microglobulin, filled in disc and paradiscal ligaments, with adjacent end-plate destruction by cytokine-mediated reactive inflammation, and appeared to be mostly related to the pathogenesis of DSA. The cervical spine, especially C5/6, is the most common site of DSA. Spinal instability and neurologic compression cause the clinical symptoms and signs. Adequate decompression and successful cervical fusion ensure the best therapeutic results.

Cervical Vertebrae↗

Tibial shaft malunion treated with reamed intramedullary nailing: a revised technique.

Thirty-seven consecutive adult tibial shaft malunions which had not undergone surgical treatment were prospectively treated with reamed intramedullary nailing. Indications for this treatment modality included a malunion of a tibial shaft which had only been conservatively treated, lesion level fitting for traditional or locked reamed intramedullary nail fixation, less than 2 cm shortening, and without evidence of deep infection at present. The malunions were treated with fibulotomy, closed wedge tibial osteotomy, open reaming of the marrow cavity, stable reamed intramedullary nail stabilization with or without supplementation, and cancellous bone grafting. Thirty-four (92%) patients were followed up for at least 1 year (range 1.0-4.3 years), and all achieved a solid union. The union period was 5.8+/-0.8 months. Complications included 2 (6%) patients with deep infection and 1 (3%) with cortical perforation. However, all 3 patients recovered completely after adequate management. In conclusion, a reamed intramedullary nail is an ideal instrument for tibial shaft malunions in indicated cases. Good exposure of the bony segments to ream the marrow cavity precisely can avoid cortical perforation. Gentle dissection of the soft tissues may lower the infection rate. Concomitant cancellous bone grafting can improve the union rate.

Adolescent↗

Arthroscopic double-bundled posterior cruciate ligament reconstruction with quadriceps tendon-patellar bone autograft.

An arthroscopic technique for double-bundled reconstruction for posterior cruciate ligament with quadriceps tendon-patellar bone autograft is presented. Anterolateral and posteromedial tunnels were created to simulate and reproduce the double-bundle structure of the posterior cruciate ligament. The bone plug is situated at the tibial tunnel and fixed by a titanium interference screw. Each of the bundles of tendon graft is rigidly fixed at the femoral tunnel with a bioabsorbable screw.

Arthroscopy↗

Complications of liner locking system in Micro-structured Omnifit acetabular components: a radiographic evaluation of 887 hips followed for 5-10 years.

We evaluated 887 hips in 672 patients with uncemented MicroStructured Omnifit acetabular components for liner locking complications. We found 2 types of radiographic signs of liner locking system complications in 7 hips, developing between 2 and 4 years postoperatively. The incidence of liner locking system complications was 0.8% using this modular acetabular component. We recommend that a patient who has received a total hip arthroplasty including a MicroStructured Omnifit acetabular component should be monitored frequently for radiographic signs of liner locking system complications, especially with a polyethylene thickness of less than 8 mm.

Adult↗

Treatment of deltoid contracture in adults by distal release of the deltoid.

Twenty-five consecutive adult patients (32 shoulders) with deltoid contracture were treated with distal release and followed up for an average of 4 years (range, 2-8 years). All shoulders achieved full range of motion and complete relief of pain and deformity after 3 months. No muscle weakness was clinically evident. In addition, another five adult patients (nine shoulders) with deltoid contracture were treated with distal release and quantitative measurement of muscle power recovery around the shoulder with Cybex 340 dynamometer before surgery, and 3 months and 1 year after surgery. Isokinetic peak torque of shoulder muscles did not decrease significantly at either 60 degrees per second or 180 degrees per second angular velocity after surgery. In addition, the shoulder extensors showed a twofold increase of isokinetic peak torque after surgical release of deltoid contracture. Distal release was a simple and effective surgical technique to treat deltoid contracture in adults. All patients in this series achieved a satisfactory outcome.

Adult↗

Bipolar versus total hip arthroplasty for hip osteonecrosis in the same patient.

The authors studied 28 patients with bilateral avascular necrosis of the femoral head who were treated with a cementless bipolar endoprosthesis in one hip and cementless total hip arthroplasty in the other. All the hips selected for bipolar endoprostheses were classified as having avascular necrosis of the femoral head Ficat Stage III, and all the hips selected for total hip arthroplasty were classified as having Ficat Stage IV avascular necrosis. After a midterm followup of an average of 6.4 years (range, 4-12 years), 24 of 28 hips that received bipolar endoprostheses were considered satisfactory, whereas 23 of 28 hips in which an arthroplasty was done were considered satisfactory. After a followup of more than 6 years, the cartilaginous space of the acetabulum could be preserved in 25 hips (89.3%) that received a bipolar endoprosthesis. There were no statistical differences in both groups in terms of clinical result, thigh pain, groin pain, osteolysis, dislocation, and revision rate. Total hip arthroplasty is not the preferred treatment for all patients with hip osteonecrosis. In young patients with Ficat Stage III osteonecrosis with Grade 0 or Grade I cartilage, the use of a cementless bipolar endoprosthesis with a bone ingrowth stem may be considered as an alternative to total hip arthroplasty.

Adult↗

Biomechanical comparison for different configurations of tension band wiring techniques in treating an olecranon fracture.

BACKGROUND: The aim of this study was to compare the superiority between the newly designed modified AO tension band wiring technique and the traditional modified AO tension band wiring technique in treating an olecranon fracture. METHODS: Eight pairs of fresh cadaveric ulnae were tested biomechanically. After transverse osteotomy of the olecranon, all left ulnae were fixed by the traditional modified AO technique with two Kirschner wires inserted through the anterior ulnar cortex and all right ulnae by the new technique with two Kirschner wires inserted into the marrow cavity from the olecranon to the ulnar styloid process. All specimens were tested by the Material Testing System machine to evaluate fragment displacement and the maximal failure load. A dual linear variable displacement transducer was used to measure relative minimal displacement. RESULTS: There was no significant difference between the techniques. The maximal failure load by either technique was more than 80 kg. Even at testing failure, no Kirschner wires migrated proximally. CONCLUSION: The new technique may be applied widely to treat all olecranon fractures, because it is a technically easier and safer technique. Less than 5.5-kg loads could be permitted in daily activity postoperatively. A single tolerable loading weight should not exceed 8 kg. Kirschner wires will not migrate proximally, despite increased joint loading. Clinically, this study may confirm indirectly the hypothesis that proximal migration of Kirschner wires was mainly due to triceps traction.

Adolescent↗

Vascular endothelial growth factor expression predicts outcome and lymph node metastasis in squamous cell carcinoma of the esophagus.

Vascular endothelial growth factor (VEGF) expression and tumor microvessel density (MVD) were examined by immunohistochemical staining in 117 cases of thoracic esophageal squamous cell carcinoma. Thirty-six (31%) of the 117 cases were evaluated as VEGF-positive. The average number of metastatic lymph nodes at surgery was 5.6 in the VEGF-positive cases and 3.0 in the VEGF-negative cases and was significantly higher in those with VEGF-positive cases (P = 0.04). The incidence of pathological tumor (PT)2-4 cases among the high-MVD cases was significantly higher than among the low-MVD cases (P = 0.01). MVD was 59.4 +/- 4.7 (mean +/- SE)/mm2 in the VEGF-positive cases and 47.9 +/- 3.8/mm2 in the VEGF-negative cases. The MVD of the VEGF-positive tumors was higher than that of VEGF-negative tumors, but the difference was not significant (P = 0.08). The survival rate of the patients with high-MVD tumors was significantly poorer than those with low-MVD tumors, and the survival rate of those patients with VEGF-positive tumors was significantly poorer than in those with VEGF-negative tumors (P = 0.009 and P = 0.04, respectively). The cumulative survival rates in the VEGF-positive groups were found to be significantly poorer in the pT3 and pathological node (pN)1 groups when stratified according to pT factor (pathological T category) and pN factor (pathological N category) in the tumor-node-metastasis (TNM) classification. VEGF expression had the second highest hazard ratio in the multivariate analysis, after pN factor. These results indicate that VEGF is a useful marker for predicting the outcome in patients with more advanced esophageal squamous cell carcinoma. It seems that TNM factors and VEGF expression are important factors in the selection of appropriate treatments.

Adult↗

Characterization of acrylic bone cement using dynamic mechanical analysis.

Dynamic mechanical analysis (DMA) was used to characterize the properties of acrylic bone cement with the addition of tricalcium phosphate (TCP), hydroxyethyl methacrylate (HEMA), and ethylene glycol dimethacrylate (EGDMA). The glass transition temperature of acrylic bone cement is >100 degrees C; the cement has a flat modulus response near human body temperature. The height of the damping peak decreases and becomes broader with increasing TCP content. Thus, TCP is incompatibile with acrylic bone cement. When the frequency is changed from high to low, the damping peak shifts to low temperature. The shift in damping peak with frequency indicates that this relaxation is time-dependent. When acrylic bone cement contains TCP with HEMA and EGDMA, the incompatibility between acrylic bone cement and TCP can be ameliorated.

Biocompatible Materials↗

In vitro elution of vancomycin from biodegradable beads.

The current antibiotics delivery system for orthopedic infection treatment uses polymethylmethacrylate (PMMA) beads as a drug release. However the nonbiodegradable nature of the PMMA necessitates a second operation to remove the beads. This article explores the alternative of using biodegradable polymers as antibiotic beads for a long-term drug release. The effect of different processing factors on the release rate of the beads was investigated. To manufacture an antibiotic bead, polylactide-polyglycolide copolymers were mixed with vancomycin. The mixture was compressed and sintered at 55 degrees C to form beads of different sizes. An elution method was employed to characterize the release rate of antibiotic over a 35-day period at 37 degrees C. Biodegradable beads released high concentrations of antibiotic (well above the breakpoint sensitivity concentration) in vitro for the period of time needed to treat bone infection; i.e., 4-6 weeks. A bacterial inhibition test was carried out to determine the relative activity of the released antibiotics. The diameter of the sample inhibition zone ranged from 6.5-10 mm, which is equivalent to 12.5-100% of relative activity. By changing the processing parameters, we were able to control the release rate of the beads. This provides advantages of meeting the specific antibiotics requirement for patients with various surgical infections.

Anti-Bacterial Agents↗