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Wang Y, Khan HM, Zhou C, Liao X, Tang P, Song P, Gui X, Li H, Chen Z, Liu S, Cen Y, Zhang Z, Li Z. Apoptotic cells derived micro/nano-sized extracellular vesicles in tissue regeneration. NANOTECHNOLOGY REVIEWS 2022. [DOI: 10.1515/ntrev-2022-0049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Abstract
Extracellular vesicles (EVs), products released by cells in multiple biological activities, are currently widely accepted as functional particles and intercellular communicators. From the orthodox perspective, EVs derived from apoptotic cells (apoEVs) are responsible for cell debris clearance, while recent studies have demonstrated that apoEVs participate in tissue regeneration. However, the underlying mechanisms and particular functions in tissue regeneration promotion of apoEVs remain ambiguous. Some molecules, such as caspases, active during apoptosis also function in tissue regeneration triggered by apoptosis,. ApoEVs are generated in the process of apoptosis, carrying cell contents to manifest biological effects, and possessing biomarkers to target phagocytes. The regenerative effect of apoEVs might be due to their abilities to facilitate cell proliferation and regulate inflammation. Such regenerative effect has been observed in various tissues, including skin, bone, cardiovascular system, and kidney. Engineered apoEVs are produced to amplify the biological benefits of apoEVs, rendering them optional for drug delivery. Meanwhile, challenges exist in thorough mechanistic exploration and standardization of production. In this review, we discussed the link between apoptosis and regeneration, current comprehension of the origination and investigation strategies of apoEVs, and mechanisms in tissue regeneration by apoEVs and their applications. Challenges and prospects are also discussed here.
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Affiliation(s)
- Yixi Wang
- Department of Burn and Plastic Surgery, West China School of Medicine, West China Hospital, Sichuan University , 610041 , Chengdu , China
| | - Haider Mohammed Khan
- Orthopedic Research Institute, Department of Orthopedics, West China Hospital, Sichuan University , Chengdu Sichuan, 610041 , China
| | - Changchun Zhou
- College of Biomedical Engineering, Sichuan University , Chengdu 610064 , China
- National Engineering Research Center for Biomaterials, Sichuan University , Chengdu 610064 , China
| | - Xiaoxia Liao
- Department of Burn and Plastic Surgery, West China School of Medicine, West China Hospital, Sichuan University , 610041 , Chengdu , China
| | - Pei Tang
- Department of Burn and Plastic Surgery, West China School of Medicine, West China Hospital, Sichuan University , 610041 , Chengdu , China
| | - Ping Song
- College of Biomedical Engineering, Sichuan University , Chengdu 610064 , China
- National Engineering Research Center for Biomaterials, Sichuan University , Chengdu 610064 , China
| | - Xingyu Gui
- College of Biomedical Engineering, Sichuan University , Chengdu 610064 , China
- National Engineering Research Center for Biomaterials, Sichuan University , Chengdu 610064 , China
| | - Hairui Li
- Department of Burn and Plastic Surgery, West China School of Medicine, West China Hospital, Sichuan University , 610041 , Chengdu , China
| | - Zhixing Chen
- Department of Burn and Plastic Surgery, West China School of Medicine, West China Hospital, Sichuan University , 610041 , Chengdu , China
| | - Shiyu Liu
- State Key Laboratory of Military Stomatology & National Clinical Research, Center for Oral Diseases & Shaanxi Key Laboratory of Oral Diseases, Center for Tissue Engineering, Fourth Military Medical University , Xi’an , Shaanxi, 710032 , China
| | - Ying Cen
- Department of Burn and Plastic Surgery, West China School of Medicine, West China Hospital, Sichuan University , 610041 , Chengdu , China
| | - Zhenyu Zhang
- Department of Burn and Plastic Surgery, West China School of Medicine, West China Hospital, Sichuan University , 610041 , Chengdu , China
| | - Zhengyong Li
- Department of Burn and Plastic Surgery, West China School of Medicine, West China Hospital, Sichuan University , 610041 , Chengdu , China
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Huang Y, Ernstbrunner L, Robinson DL, Lee PVS, Ackland DC. Complications of Reverse Total Shoulder Arthroplasty: A Computational Modelling Perspective. J Clin Med 2021; 10:5336. [PMID: 34830616 PMCID: PMC8625535 DOI: 10.3390/jcm10225336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/09/2021] [Accepted: 11/09/2021] [Indexed: 11/29/2022] Open
Abstract
Reverse total shoulder arthroplasty (RTSA) is an established treatment for elderly patients with irreparable rotator cuff tears, complex proximal humerus fractures, and revision arthroplasty; however, with the increasing indications for RTSA over the last decade and younger implant recipients, post-operative complications have become more frequent, which has driven advances in computational modeling and simulation of reverse shoulder biomechanics. The objective of this study was to provide a review of previously published studies that employed computational modeling to investigate complications associated with RTSA. Models and applications were reviewed and categorized into four possible complications that included scapular notching, component loosening, glenohumeral joint instability, and acromial and scapular spine fracture, all of which remain a common cause of significant functional impairment and revision surgery. The computational shoulder modeling studies reviewed were primarily used to investigate the effects of implant design, intraoperative component placement, and surgical technique on postoperative shoulder biomechanics after RTSA, with the findings ultimately used to elucidate and mitigate complications. The most significant challenge associated with the development of computational models is in the encapsulation of patient-specific anatomy and surgical planning. The findings of this review provide a basis for future direction in computational modeling of the reverse shoulder.
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Affiliation(s)
- Yichen Huang
- Department of Biomedical Engineering, University of Melbourne, Parkville, VIC 3010, Australia; (Y.H.); (L.E.); (D.L.R.); (P.V.S.L.)
| | - Lukas Ernstbrunner
- Department of Biomedical Engineering, University of Melbourne, Parkville, VIC 3010, Australia; (Y.H.); (L.E.); (D.L.R.); (P.V.S.L.)
- Department of Orthopaedic Surgery, Royal Melbourne Hospital, Parkville, VIC 3050, Australia
- Melbourne Orthopaedic Group, Windsor, VIC 3181, Australia
| | - Dale L. Robinson
- Department of Biomedical Engineering, University of Melbourne, Parkville, VIC 3010, Australia; (Y.H.); (L.E.); (D.L.R.); (P.V.S.L.)
| | - Peter Vee Sin Lee
- Department of Biomedical Engineering, University of Melbourne, Parkville, VIC 3010, Australia; (Y.H.); (L.E.); (D.L.R.); (P.V.S.L.)
| | - David C. Ackland
- Department of Biomedical Engineering, University of Melbourne, Parkville, VIC 3010, Australia; (Y.H.); (L.E.); (D.L.R.); (P.V.S.L.)
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Influence of subscapularis stiffness with glenosphere lateralization on physiological external rotation limits after reverse shoulder arthroplasty. J Shoulder Elbow Surg 2021; 30:2629-2637. [PMID: 34015434 DOI: 10.1016/j.jse.2021.04.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/22/2021] [Accepted: 04/25/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Repair of the subscapularis following reverse shoulder arthroplasty (RSA) remains a controversial topic among surgeons. Poor rotator cuff muscle quality is associated with increased musculotendinous stiffness, and the subsequent effect of compromised tissue repair on RSA functional outcomes remains unclear. The objective was to investigate the influence of subscapularis stiffness together with glenoid component lateralization on pre- and postimpingement joint mechanics during external rotation after RSA. METHODS A validated finite element model incorporating the Zimmer Trabecular Metal reverse system was used. The deltoid and subscapularis tendon were tensioned and wrapped around the joint prior to controlled shoulder external rotation. Baseline subscapularis stiffness, determined from cadaveric testing, was varied to 80%, 120% and 140% of baseline, to simulate a range of pliability associated with fatty infiltration and fibrosis. We evaluated the effects of varying subscapularis stiffness and the corresponding variation in joint tension with varying glenosphere lateralization (2, 4, and 10 mm) on the torque required to externally rotate the shoulder and the impingement/subluxation risk. RESULTS Prior to any impingement, the torques required to externally rotate the shoulder ranged from 22-47 Nm across the range of parameters studied, with the greatest torques required for the 10-mm glenosphere lateralization. The impact of increasing subscapularis stiffness on torque requirements was most pronounced at the 10-mm lateralization, as well. A 20% increase in subscapularis stiffness necessitated a 7%-14% increase in preimpingement torque, whereas a 40% stiffness increase was associated with a 12%-27% increase in torque. Torque was proportional to lateralization. When lateralization was increased from 2 to 4 mm, the preimpingement torque increased by 10%-13%, whereas a 10-mm lateralization necessitated a 35%-62% torque increase relative to 2 mm of lateralization. Increased subscapularis stiffness did not limit impingement-free range of motion or substantially decrease postimpingement subluxation in this model. DISCUSSION Mechanical gains achieved through lateralization may be hindered by increased torque demands, especially when a stiffer subscapularis is repaired. As lateralization increases subscapularis tension, greater torque is required to externally rotate the shoulder. The torque required for external rotation has been reported between 15-50 Nm. Subscapularis repair with the simulated increases in stiffness requires relative increases in torque that the reconstructed shoulder may not be able to physically produce to rotate the glenohumeral joint, particularly at 10-mm lateralization. These results suggest that subscapularis repair may not be indicated in cases where a lateralized glenoid component is used and the subscapularis is compromised.
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