Jung-Pan Wang

Allogeneic Mesenchymal Stem Cells in Combination with Hyaluronic Acid for the Treatment of Osteoarthritis in Rabbits

Mesenchymal stem cell (MSC)-based therapies may aid in the repair of articular cartilage defects. The purpose of this study was to investigate the effects of intraarticular injection of allogeneic MSCs in an in vivo anterior cruciate ligament transection (ACLT) model of osteoarthritis in rabbits. Allogeneic bone marrow-derived MSCs were isolated and cultured under hypoxia (1% O2). After 8 weeks following ACLT, MSCs suspended in hyaluronic acid (HA) were injected into the knees, and the contralateral knees were injected with HA alone. Additional controls consisted of a sham operation group as well as an untreated osteoarthritis group. The tissues were analyzed by macroscopic examination as well as histologic and immunohistochemical methods at 6 and 12 weeks post-transplantation. At 6 and 12 weeks, the joint surface showed less cartilage loss and surface abrasion after MSC injection as compared to the tissues receiving HA injection alone. Significantly better histological scores and cartilage content were observed with the MSC transplantation. Furthermore, engraftment of allogenic MSCs were evident in surface cartilage. Thus, injection of the allogeneic MSCs reduced the progression of osteoarthritis in vivo.

Lunocapitate fusion with scaphoid excision for the treatment of scaphoid nonunion advanced collapse or scapho-lunate advanced collapse wrist

Background Four‐corner fusion is an effective procedure to treat advanced degenerative osteoarthritis of scaphoid nonunion advanced collapse or scapho‐lunate advanced collapse wrists. However, lunocapitate fusion, an alternative procedure, shows benefits including less dissection of the soft tissue and also a shorter operation time. We reviewed 10 cases to reveal the complication rates and clinical outcomes of this procedure. Methods We retrospectively reviewed 10 patients with symptomatic scaphoid nonunion advanced collapse or scapho‐lunate advanced collapse wrists who had received lunocapitate fusion with scaphoid excision. The average follow‐up period was 44.5 months (range, 22–68 months). Clinical evaluations were conducted and determined by radiographs, range of motion (flexion–extension), visual analog scale, and Mayo wrist scores. Complications including nonunion and implant migration were recorded. Results Among these patients, eight developed solid radiographic union while the remaining two patients showed bone resorption and implant migration and needed revision surgeries. The visual analog scale was decreased from 5.0 to 1.1, and the flexion–extension arc was increased from 61° to 72.5°. The average Mayo Wrist Score was 70 points. The results showed outcomes similar to those of previous studies. Conclusion Through our investigation and findings, we conclude that lunocapitate fusion can restore a functional and almost pain‐free wrist. Moreover, these results were maintained at follow‐up sessions, with complication rates being similar to those of previous studies. These results conclude a satisfactory therapeutic alternative to four‐corner fusion for advanced degenerative osteoarthritis of wrists.

Open versus percutaneous release for trigger digits: Reversal between short-term and long-term outcomes.

Background There have been excellent outcomes reported with both open and percutaneous release of trigger finger. However, a comparison of short‐ and long‐term outcomes between these two techniques has not been performed. The purpose of this study is to compare the short‐term (3 months) and long‐term (2 years) outcomes between open surgical release and percutaneous needle release of trigger finger. Methods Between 2009 and 2012, a total of 198 patients with trigger finger treated with either open (n = 72) or percutaneous (n = 126) release of the A1 pulley were enrolled in the study. Both short‐term and long‐term outcomes were evaluated, using the criteria established through Gilberts et als questionnaire. Results The short‐term satisfaction of patients with their results was significantly better in the percutaneous release group, whereas the long‐term satisfaction rates were better in the open‐release group, although not at a statistically significant level. Conclusion The percutaneous release method to release trigger finger does not have a better long‐term satisfaction rate than the open release approach, although percutaneous release has a significantly better short‐term satisfaction rate.

Multi-lineage differentiation and angiogenesis potentials of pigmented villonodular synovitis derived mesenchymal stem cells--pathological implication.

Pigmented villonodular synovitis (PVNS) is a benign tissue proliferation characterized by its hyper‐vascularity within the lesion. The true etiology and cell source of this disease entity still remain unclear. Mesenchymal stem cells (MSCs) exist in various tissues of human body. However, it has not been clarified whether MSCs could be isolated from tissue of PVNS. Here, we isolated MSCs from PVNS (PVNS‐SCs), and by comparing to the MSCs from normal synovium (Syn‐SCs) of the same individual, we investigated whether PVNS‐SCs differed in the capacity for multi‐differentiation and inducing angiogenesis. We first demonstrated that PVNS‐SCs existed in the lesion of PVNS of three individuals. Moreover, we showed PVNS‐SCs had better osteogenic differentiation potential than Syn‐SCs, whereas Syn‐SCs had better capacity for adipogenic and chondrogenic differentiation. By genome–wide analysis of gene expression profile using a complementary DNA microarray and comparing to Syn‐SCs, we identified in PVNS‐SCs a distinct gene expression profile characterized by up‐regulation of genes involved in angiogenesis. In vitro and in vivo studies further confirmed that PVNS‐SCs had better capacities for promoting angiogenesis. In summary, the identification of PVNS‐SCs in PVNS tissue and their distinct angiogenic potential may help elucidate the underlying etiology of this disease.

Surgical Treatment of Open Diaphyseal Fractures of Both the Radius and Ulna

Background: This study was designed to determine the effects of surgical treatment of acute, open and displaced diaphyseal fractures of both the radius and ulna by early debridement, reduction and internal fixation with a dynamic compression plate (DCP). Methods: From 1991 to 2003, data from 25 patients with acute, open and displaced diaphyseal fractures of both the radius and ulna were collected and evaluated retrospectively. Twenty‐four patients were managed with early surgical debridement, open reduction and internal fixation with a DCP, and 1 fracture was reduced and fixed 3 days after the initial injury. The mean follow‐up period was 74.7 months (standard deviation [SD], 38.6 months; range, 16‐150 months). All patients had complete functional and radiographic assessments. Results: Twenty‐four patients (96%) achieved normal union in a mean of 20.2 weeks (SD, 3.8 weeks; range, 12‐24 weeks). One patient with an open type I fracture had nonunion. Functional outcomes showed that 15 patients had excellent results, 8 had satisfactory results, 1 had an unsatisfactory result, and there was 1 failure. There was 1 delayed superficial wound infection. Conclusion: Early meticulous debridement, good open reduction and internal fixation with a small DCP proved very effective in the management of type I and II open fractures of both the radial and ulnar diaphyses.

Corticosteroid inhibits differentiation of palmar fibromatosis-derived stem cells (FSCs) through downregulation of transforming growth factor-β1 (TGF-β1)

Treatment for musculoskeletal fibromatosis remains challenging. Surgical excision for fibromatosis is the standard therapy but recurrence remains high. Corticosteroids, an anti-fibrogenic compound, have been used to treat early stage palmar fibromatosis, but the mechanism is unknown. We investigated the inhibitory mechanism effect of corticosteroids in the murine model of fibromatosis nodule as well as in cultured FSCs. Quantitative reverse transcription/polymerase chain reaction (PCR) analysis and immunofluorescence (IF) staining for markers of myofibroblasts (α-smooth muscle actin and type III collagen) were used to examine the effect of dexamethasone on myofibroblasic differentiation of FSCs both in vitro and in vivo. Transforming growth factor-β1 (TGF-β1) signaling and its downstream targets were examined using western blot analysis. TGF-β1 expression in FSCs before and after dexamethasone treatment was compared. In addition, inhibition of TGF-β1 expression was examined using RNA interference (RNAi) on FSCs, both in vitro and in vivo. Treating FSCs with dexamethasone inhibited FSCs’ myofibroblastic differentiation in vitro. Treating FSCs with dexamethasone before or after implantation further inhibited formation of fibromatosis nodules. Dexamethasone suppressed expression of TGF-β1 and pSmad2/3 by FSCs in vitro. TGF-β1 knockdown FSCs showed reducing myofibroblastic differentiation both in vitro and in vivo. Finally, addition of TGF-β1 abolished dexamethasone-mediated inhibition of myofibroblastic differentiation. Dexamethasone inhibits the myofibroblastic differentiated potential of FSCs both in vitro and in vivo through inhibition of TGF-β1 expression in FSCs. TGF-β1 plays a key role in myofibroblastic differentiation.

Recurrence rate of the Paine retinaculotome carpal tunnel release in diabetic and non-diabetic patients at long-term follow-up

Background Carpal tunnel release (CTR) is considered effective in treating carpal tunnel syndrome (CTS), and diabetes is considered to complicate the outcome and recovery. However, the difference in recurrence rate between diabetic and non‐diabetic patients after mini‐open CTR in the long‐term has not yet determined. Methods This study enrolled 1251 wrists (1091 patients), with 841 (67%) females and 480 (33%) males at a mean age of 58.5 years at operation. Patients were followed for a mean duration of 10.5 years. We retrospectively compared the recurrence rates of the Paine retinaculotome for mini‐open CTR at wrist in diabetic and non‐diabetic patients. Results In our study, a total of 161 wrists (13%) were in the diabetic patients and 1090 wrists (87%) were in the non‐diabetic patients. Two wrists (1.24%) in the diabetic group and seven (0.6%) in the non‐diabetic group exhibited recurrence (p = 0.325). Conclusion The mini‐open CTR with the Paine retinaculotome in diabetic patients didn’t show significantly higher recurrence rate than that in non‐diabetic patients in the long term.