Abstract Background: Periprosthetic joint infection (PJI) is a catastrophic complication after total knee or hip arthroplasty. The diagnosis of PJI is very difficult, especially in the early postoperative period. The value of the neutrophil to lymphocyte ratio (NLR) is useful for diagnosing infectious diseases. The objective of this study was to investigate the accuracy of the NLR for the diagnosis of early PJI after total knee or hip arthroplasty. Methods: We retrospectively evaluated consecutive primary total knee or hip arthroplasty and identified the patients who readmitted within the first 90 days postoperatively between January 2011 and October 2018.There were 20 cases diagnosed early PJI and 101 uninfected cases on the basis of the modified Musculoskeletal Infection Society (MSIS) criteria. The serum parameters including C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), white blood-cell (WBC) count, NLR and interleukin-6 (IL-6) were compared between the two groups. Receiver operating characteristic curves were generated to estimate the optimal cutoff values for each parameter.The sensitivity, specificity, positive predictive value and negative predictive value for each parameter were calculated. Results: The CRP, ESR, WBC, NLR and IL-6 values were all significally higher in the infected group than the uninfected group. The median of CRP was 66.6 mg/l in the infected group and 8.6mg/l in the uninfected group (p<0.001). The median of ESR was 34.8 mm/hr in the infected group and 17.4mm/hr in the uninfected group (p<0.001). In the infected group and uninfected group, the median of WBC was 8.2X10 9 /L and 6.1 X10 9 /L (p = 0.002), respectively; while the median of NLR was 5.2 and 2.1 (p<0.001). The median of IL-6 was 46pg/ml and 6.4pg/ml (p<0.001),respectively. The best parameter for the diagnosis of early PJI was IL-6 (AUC=0.814) followed by the NLR (AUC =0.802), CRP (AUC =0.793), ESR (AUC =0.744) and WBC (AUC = 0.632). Conclusions: This study is the first to show that NLR values are more accurate than CRP and may be considered as useful parameters for the diagnosis of early PJI because it is a cheap and convenient parameter to be calculated in daily practice without extra costs.
Objective Periprosthetic fracture in total hip arthroplasty (THA) can be catastrophic, and early detection and appropriate management are vital to the overall prognosis. This study aimed to describe and summarize the features of undetected intraoperative periprosthetic femoral fractures (IPFFs) in primary THA patients and treatment measures and to review the relevant literature. Methods We reviewed a total of 6350 primary THAs performed at our institution between January 2013 and December 2020 and screened all IPFFs. Of 138 IPFFs, 24 were undetected and met the inclusion criteria. We recorded and compared basic patient and operative information and measured some parameters to evaluate canal morphologies based on preoperative radiographs. We also compared fracture line characteristics using postoperative radiographs to summarize the features of intraoperative fractures and propose treatment strategies. The Kolmogorov–Smirnov test was used to test the normality of the variable distributions. Measured parameters in all groups were analyzed using one‐way analysis of variance and compared using Dunnett's test. The χ 2 and Fisher exact tests were used to compare reoperation rates across the groups. Interrater and intrarater reliability were evaluated by intraclass correlation coefficients. Results Among the 24 hips, there was no significant difference in patient demographics, basic operative information or morphology. The incidence of IPFFs in primary THA patients was 2.17%, and up to 17.4% of IPFFs were undetected until postoperative fluoroscopy. The incidence of undetected IPFFs among all primary THA patients was 0.38% and varied by stem type, with the highest incidence in femurs with either anatomical (1.04%, 4/385) or modular stems (0.90%, 9/1003). Femurs with anatomical stems had a higher reoperation rate. The distal periprosthetic (Gruen zone 4) fracture line of femurs with tapered stems was more prone to involve the medial or lateral bone cortex, which could cause instability. Conclusion An undetected IPFF is most likely in femurs fitted with a prosthesis of an inappropriate size or type. Anatomical stems will most likely cause unstable fractures; thus, it is recommended to use them with caution and note the possibility of medial distal femoral fracture. Improper modular stem type or size selection results in longitudinal fractures of the distal femur, and prophylactic cerclage wire binding is recommended in dysplastic hips. Incorrect use of tapered stems in well‐ossified femurs may cause distal femoral fractures involving the medial or lateral bone cortex. Intraoperative fluoroscopy after implantation may help detect hidden fractures.
Background: The preoperative diagnosis of periprosthetic joint infection (PJI) depends on a series of blood biomarkers. Previous studies have shown that CD64 expression on blood neutrophils and monocytes has a good diagnostic efficacy for diagnosing systemic and local infections. The purpose of the present study was to investigate the role of blood CD64 in the diagnosis of PJI. Methods: On the basis of estimations made before the study was performed, 62 patients were recruited for joint revision surgery following the failure of primary hip or knee replacement. Venous blood was obtained within 24 hours after patient admission, and flow cytometry was performed to evaluate the CD64 expression of 3 groups of white blood cells (WBCs). CD64 expression was measured as CD64 mean fluorescence intensity (CD64MFI). The neutrophil CD64 index (nCD64 index; neutrophil CD64MFI [nCD64MFI]/lymphocyte CD64MFI [lCD64MFI]) and monocyte CD64 index (mCD64 index; monocyte CD64MFI [mCD64MFI]/lCD64MFI) were then calculated. The C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) at admission, synovial fluid indicators, leukocyte esterase test results, intraoperative histological results, and tissue or synovial fluid culture results were recorded. According to the modified Musculoskeletal Infection Society (MSIS) criteria, patients were divided into the PJI group and the non-PJI group. These blood indicators were then analyzed for the diagnosis of PJI. Results: The PJI group included 18 patients, and the non-PJI group included 44 patients. The diagnostic value of the area under the receiver operating characteristic curve (AUC) was low for lCD64MFI, the nCD64 index, and the mCD64 index. The diagnostic value for nCD64MFI was moderate, with an AUC of 0.735 (95% confidence interval [CI], 0.595 to 0.874; p = 0.004). The diagnostic value for mCD64MFI was high, with an AUC of 0.898 (95% CI, 0.821 to 0.975; p < 0.001). The cutoff value for mCD64MFI was 28,968, with a sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 1, 0.75, 0.62, and 1, respectively. This result was confirmed by internal validation with a different antibody. Conclusions: Flow cytometry can be used for patient screening before revision surgery, and blood mCD64MFI is a promising indicator for PJI. Level of Evidence: Diagnostic Level II . See Instructions for Authors for a complete description of levels of evidence.
Subtrochanteric shortening osteotomy (SSO) is often applied during total hip arthroplasty (THA) in high hip dislocations. The aim of the present paper was to evaluate the results of fixation by autogenous cortical plate technique on sites of SSO in THA for patients with Crowe type IV developmental dysplasia of the hip (DDH).We conducted a historical prospective cohort study and reviewed 67 patients (82 THAs) with SSO performed between March 2016 and May 2020. Thirty-nine patients (48 hips) obtained stability by intramedullary pressure provided by the S-ROM modular prostheses and with or without prophylactic binding by stainless-steel wire after osteotomy and before stem implantation (group A). Twenty-eight patients (34 hips) were fixed with autogenous cortical plate technique and stainless-steel wire or cables (group B). Time of operations, complications, radiographic results and clinical scores were compared.One intraoperative fracture and a dislocation occurred, while component loosening, ectopic ossification and osteolysis were not observed. Group B had a higher union rate at the 4th month than group A (P = 0.015) while there were no significant differences of union rates at the 8th (P = 0.811) and the 12th month (P = 0.722) and of the average healing time (P = 0.181). No significant differences were found in hip function scores (HHS and WOMAC Osteoarthritis Index) between two groups.Fixation with autogenous cortical plate from the cylinder of femoral bone contributes to early bone union of osteotomy ends in Crowe type IV DDH patients compared to those who do not apply the technique. Besides of application of autogenous cortical strut grafts, relevant measures are as well recommended to prevent nonunion after SSO.
To investigate the effect of dynamic compression and rotation motion on chondrogenesis of the 3rd passage cell-loaded three-dimensional scaffold in a joint-specific bioreactor in vitro so as to provide theoretical basis of the autologous chondrocyte transplantation in clinical practice.Primary chondrocytes were isolated and cultured from the knee cartilage of 3-4 months old calves. The 3rd passage cells were seeded onto fibrin-polyurethane scaffolds (8 mm x 4 mm). Experiment included 5 groups: unloaded culture for 2 weeks (group A), direct load for 2 weeks (group B), unloaded culture for 4 weeks (group C), direct load for 4 weeks (group D), and unload for 2 weeks followed by load for 2 weeks (group E). The cell-scaffold was incubated in incubator (unload) or in a joint-specific bioreactor (load culture). At different time points, the samples were collected for DNA and glycosaminoglycan (GAG) quantification detect; mRNA expressions of chondrogenic marker genes such as collagen type I, collagen type II, Aggrecan, cartilage oligomeric matrix protein (COMP), and superficial zone protein (SZP) were detected by real-time quantitative PCR; and histology observations were done by toluidine blue staining and immunohistochemistry staining.No significant difference was found in DNA content, GAG content, and the ratio of GAG to DNA among 5 groups (P > 0.05). After load, there was a large number of GAG in the medium, and the GAG significantly increased with time (P < 0.05). The mRNA expression of collagen type I showed no significant difference among 5 groups (P > 0.05). The mRNA expression of collagen type II in group B was significantly increased when compared with group A (P < 0.01), and groups D and E were significantly higher than group C (P < 0.01); the mRNA expression of Aggrecan in groups D and E were significantly increased when compared with group C (P < 0.01), and group E was significantly higher than group D (P < 0.01); the mRNA expression of COMP in group B was significantly increased when compared with group A (P < 0.01), and group E was significantly higher than group C (P < 0.01); and the mRNA expression of SZP in group E was significantly increased when compared with groups C and D (P < 0.05). The toluidine blue staining and immunohistochemistry staining displayed that synthesis and secretion of GAG could be enhanced after load; no intensity changes of collagen type I and collagen type II were observed, but intensity enhancement of Agrrecan was seen in groups D and E.Different dynamic loads can promote chondrogenesis of the 3rd passage chondrocytes. Culture by load after unload may be the best culture for chondrogenesis, while the 3rd passage chondrocytes induced by mechanical load hold less capacity of chondrogenesis.
Abstract Background Pancreatic cancer (PC) is one of the most lethal malignancies worldwide. Tumor suppressor long noncoding RNA on chromosome 8p12 (TSLNC8) is a newly identified long noncoding RNA (lncRNA) and play an important role in human cancers. However, the function and molecular mechanism of TSLNC8 in PC progression remains to be elucidated. Methods qRT-PCR was performed to examine the expression pattern of TSLNC8 in PC tissues and cell lines. Overexpression and knockdown experiments were conducted to detect the function of TSLNC8 in PC. The interaction between TSLNC8 and HuR was tested by RNA immunoprecipitation assay. Results Our results showed a significant increase of TSLNC8 expression in PC tissues and cell lines. Upregulation of TSLNC8 expression in PC tissues was closely correlated with TNM stage, distant and lymph node metastasis, and poor prognosis of PC patients. Functional experiments demonstrated that TSLNC8 promoted PC cells proliferation and invasion in vitro, and enhanced PC growth and metastasis in vivo. Mechanistically, TSLNC8 associated with HuR, promoted the binding of HuR with CTNNB1 mRNA and increased the stability of CTNNB1 mRNA, thus activating WNT/β-catenin signaling pathway. Conclusion Our present study revealed that oncogenic lncRNA TSLNC8 positively regulate PC growth and metastasis via HuR-mediated mRNA stability of CTNNB1, extending the understanding of PC pathogenesis regulated by lncRNAs.
The widespread application of implantable materials has brought about a corresponding increase in implant-related complications, with implant-associated infections being the most critical. Biofilms, which often form on these implants, can significantly impede the effectiveness of traditional antibiotic therapies. Therefore, strategies such as surgical removal of infected implants and prolonged antibiotic treatment have been acknowledged as effective measures to eradicate these infections. However,the challenges of antibiotic resistance and biofilm persistence often result in recurrent or hard-to-control infections, posing severe health threats to patients. Recent studies suggest that phages, a type of virus, can directly eliminate pathogenic bacteria and degrade biofilms. Furthermore, clinical trials have demonstrated promising therapeutic results with the combined use of phages and antibiotics. Consequently, this innovative therapy holds significant potential as an effective solution for managing implant-associated infections. This paper rigorously investigates and evaluates the potential value of phage therapy in addressing orthopedic implant-associated infections, based on a comprehensive review of relevant scientific literature.随着植入材料在骨科疾病治疗中的应用逐渐普及，植入物相关并发症日益增多，其中以感染为最为严重。采取手术取出感染植入物并延长抗菌药物用药时间已被视为根除感染的有效策略。然而，由于抗菌药物耐药和生物膜的存在，感染难以控制或复发的情况屡见不鲜，对患者健康构成严重威胁。最新研究结果显示，噬菌体不仅可以直接杀灭致病菌，还具备降解生物膜的能力。联合使用噬菌体和抗菌药物，在临床试验中展现出了良好的治疗效果，有望成为处理植入物相关感染的有效解决方案。.
Background: Total knee arthroplasty has been increasingly used for young and active patients, and prosthesis durability is important in these patients. The accuracy of implant placement has been one of the major factors that determine the long-term survival of the prosthesis. The purpose of this study was to compare the accuracy of prosthetic alignment between computer-assisted-navigation and conventional total knee arthroplasties. Methods: From March 2007 to June 2008, thirty-two patients with bilateral knee osteoarthritis underwent simultaneous bilateral total knee arthroplasty with the same type of implant in each knee. The subjects included seven men and twenty-five women, with an average age of sixty-three years. For each patient, the bilateral total knee arthroplasty was performed with computer-assisted navigation in one knee and a conventional technique in the other. The operative technique and the order of the surgical procedures were randomized. The patients and surgeons conducting the follow-up study and performing the imaging measurements were blinded to the type of surgical procedure. Results: There was a significant difference between the two groups with regard to the alignment of the knee prosthesis in the coronal and sagittal planes. Nine knee implants (28%) in the conventional group, compared with no knee implants in the computer-navigation group, deviated >3° from the mechanical axis in the coronal plane. The coefficient variation of data in the conventional group was three times greater than that in the computer-navigation group. There was no significant difference in the rotational angle of the femoral component between the two groups. The Hospital for Special Surgery (HSS) scores at six months postoperatively were substantially increased compared with the preoperative scores in both groups. Conclusions: Computer-assisted navigation consistently provided coronal plane alignment within 3° of the mechanical axis, which was significantly better than the alignment obtained with conventional total knee arthroplasty. Level of Evidence: Therapeutic Level II. See Instructions to Authors for a complete description of levels of evidence.
The aim of the present study was to examine the effect of glycitin on the regulation of osteoblasts from bone marrow stem cells (BMSCs) through transforming growth factor (TGF)-β or protein kinase B (AKT) signaling pathways. BMSCs were extracted from New Zealand white rabbits and used to analyze the effect of glycitin on BMSCs. BMSCs were cleared using xylene and observed via light microscopy. BMSCs were subsequently induced with glycitin (0.01, 0.5, 1, 5 and 10 µM) for 7 days, and stained with Oil Red O. The mechanism of action of glycitin on BMSCs was investigated, in which contact with collagen type I (Col I), alkaline phosphatase (ALP), TGF-β and AKT was studied. Firstly, BMSCs appeared homogeneously mazarine blue, and which showed that BMSCs were successful extracted. Administration of glycitin increased cell proliferation and promoted osteoblast formation from BMSCs. Furthermore, glycitin activated the gene expression of Col I and ALP in BMSCs. Notably, glycitin suppressed protein expression of TGF-β and AKT in BMSCs. These results indicated that glycitin may regulate osteoblasts through TGF-β or AKT signaling pathways in BMSCs.
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