Dome Bigelow Black White main Bray Clinic Wan An Ambulatory (MEEI) 25 25 14.3 21.4 35. 0 1500-2500 12 Red Line
charle / MGH ( )! morning meeting Douki Dounut 88
( ) -tissue engineering-... interleukin CDM.. replacement regeneration TGFß BMP..
Activities of daily living (ADL).... 18 6 ( ) charcot joint 3.9 ( O )... ( )
Extracorporeal shockwave.. ( ).. Tramadol Norepinephrine Serotonin NSAID SCOX-2 200-300mg Codeine Acetaminophen Acetaminophen NSAIDS dextropropoxyphen Acetaminophen Warfarin sodium PTT Acetaminophen Walfarin
NSAIDS 65 20-30% (1) 65 (2) (3) (4) (5) (6) Cr 2.0mg/dl (1) 65 (2) (3) (4) (5)ACE NSAIDS ( choline magnesium trisalicytate trilisate) (1) (2) NSAIDS NSAIDS Aspirin(81-325mg) NSAIDS (1) (2) misoprostol 200µg famotidine(gaster) proton pump omeprazole 20 40mg COX-2 (1)rofecoxib (vioxx) ibuprofen diclofenac (2)celecoxib (celebrex) Naproxem cycloxygenase ( NSAIDS) Walfarin sodium sulfonamide ( celecoxib) COX-2 NSAIDS Acefaminophen methylsalicylate capsaicin Hyaluron NSAIDS COX-2 Glucocorticoids ( )40mg TriamciNolone hexacetonide
( ) Gram Crystalline Steroid Suspension FDA Acetaminophen cytokines prostaglandin Laurel Young 40 120mg methylprednisolone acetate linig CD68 30%( P 0.048) Sublining( ) CD68 chemokines monocyte chemoattractant protein 1 (MCP-1) Macrophage inflammatory protein a(mip-1a) matrix metalloproteinases 1 3(MMPs-1 MMPs-3) tissue inhibitors of metalloproteinases 1 2(TIMPs-1 TIMPs-2) lining CD68 Macrophage chemoattractants MCP-1(monocyte chemoattractant protein 1) MIP-1a MMPs TIMPs MMPs mosaicplasty morbidity tissue engineering Tidal irrigation fluorescence
Osteotomy 8 10 polyethylene polyethylene cross link polyethylene (1) Lynch 1.1% Fernandez-Baillo Grace Sim Fernandez-Baillo Lynch Grace Sim.. V-Y.. Frenandez-Baillo Dacron tape
Dr.Rubash. 0.3% 5.4% Clayton Thirupathi 18 111 Insall 88 66 Scott duopatellartka 0.5% Grace Sim 8249 12 0.15% Brick 15 2887 0.52% press-fit component malalignment fixation peges cysts hinge TKA posterior stabilized femoral component inset patellar component Grace Sim 2719 0.33% 5530 0.05%( P 0.05) Scott
372 1.3% 841 0.12% Boyd 396 0.76% 495 Healy ( P 0.04)Scott Tria 18 82% Ritter (3.6%) (1.4%) (SLGA) 495 0.61% 7754 0.12%( P 0.05) 4/5 1/5Tria 17/18 Scott 286 3 3.5% 0.7% 86 Ritter Grace Sim Brick Goldberg A B.. 14 6 B 8 A 7 5
13/22 Hozack 21 3/4 Extensor lags Hozack integrity 6 X ( ) ( ) ( )
ectatic Lettin Stanmore ( 4%) 10 20 ( 5%) Walldius 3/54 5.6% Walldius ( ) 1/62(1.6%) 35 Walldiius 5/160(3.1%) Walldius 10 35 Deburge GUEPAR 5/292(1.7%) Mayo Clinic Walldius GUEPAR 2.6% (2/77) 1/170(0.59%) Townley 2/532(0.38%)Lynch 1.4%Boyd 0.56%(5/891) Cadambi Engh 0.55% Healy 1/211(0.5% )Rand 10 4.1
20 40 106 Emerson Leopold 7 Emerson 39 30 59 50 52 Nazarian Booth Emerson 36 15 13 23 1.4 98 37 68 3.6 36 34 Leopold Emerson Nazarian Booth Cadambi Engh 7 [ 90 6 60 6 7 10 79 4 Jaureguito Gastrocnemius 6 Gastrocnemius 6 8 26 24 100 30 Gastrocnemius [ Abril Bunnel
8 85 95 Zanotti 12 - - 5 10 Chiou gastocnemius Kempenaar Cameron -20 90 Dr.Rubash (1) (2) (3) (4) (5) gastrocnemius (6) 1. 2. 3. 4. 5. autramatic taper needle6. 7. 50% 0 40 30 6 12
10 30 40 5 8 101 89 12 7 3 3 110 14 110 proinflammatory cytokines anti-(tumor neerosis factor) blocking agents cell therapy tissue engineering self repair Mesenchymal stem cells(mscs) chondrocytes Matrix Collagens Proteoglycan cygregates (aggrecan) Proinflammatory cytokines Metalloproteinase (MMP) ( Pericellular matrix degradation) interleukin 1ß 6(IL1ß IL6) ( aggregan chondral synthesis) ( /
) ( hyaluronan / aggregan ratio) IL-1 ( IL-1 receptor antagonist ) (proteoglycan depletion) RA ( synoviocytes) MMPs MMPs 18 (endopeptidases) cytokines IL6 (IL1-1 IL6 oncostatin M) MMP inducer( Extracellular matrix metalloproteinase inducer) chondrocyte synoviocyte Polymorphonuclear cells serine proteases RA Proteases Proteases inhibitors (1) MMPs tissue inhibitors of metalloproteinase (2) serine protease secretory leucocyte proteinase inhibitor (1) cytokines IL-10 proinflammatory cytokines (2) transforming growth factor ß( TGFß)( TGFß-1 bone morphogenetic protein ( BMP-2)) proteoglycan TGFß( BMP-2) IL-1 dose dependent synovial calls TGF 40 polypeptide growth factors C C-terminal region 7 cysterine residues (homology) Smad Smad Transcription factors TGFß BMPs regulate the morphogenetic events signalling mofecules BMPs chondroclasts osteoblast ( ) Morphogenetic Matrix BMPs(rhBMP-2) Lewis 5mm 80% 38% 47%. BMP-2 chemoattractant
(MSCs).BMP-2 Proliferative and differentiating (nude rats) BMP-2 pluripotent 9 12 16 Stroma Morphogenetic BMP-2 BMP-2 proteoglycan dose dependent BMP-2 TGFß1 rhbmp-2 - Safranin 0 24 70% rhbmp-2 IL-1a morphogenic BMP-2 BMP-7 osteogenic protein(op-1) IL1ß BMP-2 OP-1 TGFß CDMP-1 CDMP-2 CGDF-5 GDF-6 Indian Hedgahog PTHrP Noggin T (NFATp) MSCs NFATp Cytokines 75 76% Brittberg 87.5% 50
osteoprogenitor cells 3% apoptosis agarose aggregate TGFß1 TGFß1 TGFß1 osteogenesis imperfecta ( mutation ) 1.5 2% donor pluripotent mesenchymal MSCs pluripotent cytokines(gm-csf IL6 IL7 IL8 IL11) SDF-1 progenitors CD34 CD45 CD14 T B markers MSCs MSCs SCID/hu MSCs IL3 ceramic cubes MSCs 12 IL3 MSCs soluble tumor factor receptor?? NOD/SCID cytokine (mouse tumour necrosis factor ) MSCs pluripotent
MSCs BMP-2 91.6% BMP-2 BMP Lewis polylactic acid / polyglycolic acid 12 50% rhbmp-2 6 100% Boden BMP 4 osteoinductive rhbmp-2 polylactic 6 rhbmp-2 12 80% (osteoprogenitor cells osteoinductive factors biodegradable matrix) MSCs C3H / 10T1/2 mesenchymal C3H / 10T1/2 BMP-2 osteogenic (paracrine effect) (autocrine effect) BMP-2 C3H/10T1/2 BMP-2 MSCs Urist MSCs TGFß1 humanbmp-2 progenitor cells Caplan MSCs 2 100% Trypsin MSCs 1000000 MSCs MSCs fibrillate MSCs
compliance 5.2 11 MSCs MSCs ( ) MSCs 10 2000 MSCs cytokines Osteotomy Open wedge close wedge dome osteotomy open wedge close wedge Dome osteotomy ( ) ( ) psoas
0.4 5.8% 4.8 13% 90% femoral head component polythylene Eletron-beam irradiated highly crosslinked ultrahigh molecular weight polyethylene Electron 28mm 32mm 38mm 44mm colar stem 0 15 30 45 30 ( )0 ( )90 ( )0 impingment ( ) ( ) ( ) skirt impingment versys cllar ASIS. ASIS (1) 0 15 30.(2) 0
anteversion30>15>0.(3) 90 30>15>0.(4) 90 30<15<0 30 45.(5) Impingement(6).(7).(8).(9).(10) proximally-porous coated stems Cut-away monopolar constrained acetabular system Woo Morrey 69% Constrained Goetz 55 2 84 Cut-away 0 90 0 15 25 40 50 60 (Torque) 11 4 11 138 45 49 38 28mm 2
Interleukin-1 Interleukin-6 collagenase( ) Prostaglandin E2 TNF-a 7 518 38%.(1) ( ).(2).(3) 22mm 44mm 40 36mm 28mm 44mm 45 30 90 0 0. 10 30 28mm 32mm 38mm 44mm 38mm 44mm 58 38mm 44mm 130 38 44 36mm
1. Glucosamine and chondroitin sulfate (uartril-s) cyeloxygenase 2. pulse electromagnetic fields laser 3. E C 4. Glucose B 5. Hyaluron Shohichi.k. Artz Inteukin-6 Interleukin 8 IL-6 IL-8 Lisignoli.G. CD44 CD54 1(CAM-1) Anti-Fas-induced apoptosis Chondrocyte apoptosis 6. Autologous chondrocyte transplantation 7. Autologous osteochondral plugs (mosaicplasty) 50 8. Disease-modifying OA drugs Matrix metalloproteinase inhibitors Tissue metalloproteinase inhibitors (TIMP- 1) MMP Growth factors Transforming Growth factor ß Bone morphogenetic protein cartilage derived morphogenetic protein (CDMP-1 CDMP-2) Proteoglycan TGF-ß serine/theonine kinase ( receptor-serine / theonine kinase family) BMP BMP BMP-2 4 5 6 7( OP1) 8( OP2) 9 GDF-1 GDF-6 GDF-7 Dorsalis Vg1 limb buds mrna Protein
mesenchymal-epithelial inductive interactions craniofacial process osteoinductive osteoblastic osteoprogenitor mesenchymal phenotypes chemotaxis cells progenitors BMP mesenchymal progenitor TGF-ß1 BNP-2 phosphorylated form Cx43 GJIC( Gap Junctional intercellular communication) Cx43 mrna protein Cx43 (connexin) osteoblast protein GJIC Cx43 phosphorylation GJIC PDGF(platelet-derived growth factor)efg FGF(Fibrobrast Growth Factor). CDMP(1 2) TGF-ß( BMP-6 DP-1 ). COX-2 celecoxib Vioxx celecoxib. Nitric oxide interleukin 1ß prostagladin E2 Metalloproteinase Nitric Oxide proteoglycans TypeII interleukin 1ß receptor 1L-1ß proteoglycan. Chondrocyte. MMPs Cytokines TypeII interleukin -1 receptor TypeII soluble interlukin-1 receptor interlukin-1 receptor antagonisys NSAID TIMP-1 MMP-1 activity Collagenase Proteoglycanase TIMP-1 activity Expression Activity Indomethacin biosynthesis Meloxicam biosynthesis Naproxem biosynthesis biosynthesis Dexamethasone Interleukin-1 Expression Expression MMR3 activity
Dexamethasone activity loss of Expression