Introduction:Osteoarthritis is the most prevalent progressive musculoskeletal disease. It leads to functional impairment and decreased quality of life. However, the current treatments remain unsatisfactory. Recent studies have revealed that exosomes derived from mesenchymal stem cells offer a promising approach to improve the pathological changes in osteoarthritis, cartilage tissue, and chondrocyte homeostasis. Material and methods:In this in vitro and in vivo study, we studied the effects and mechanisms of dental pulp stem cell-derived exosomes (DPSC-exosomes) on osteoarthritis in a mouse model. Results:The study findings showed that a dental pulp stem cell could generate typical characteristic exosomes. The injection of DPSC-exosomes ameliorated destruction of cartilage, promoted matrix synthesis, inhibited cell apoptosis, and decreased the expression of catabolic factors. However, this effect was shown to be almost eliminated when miR-31 antagomir was injected. Conclusions:Furthermore, DPSC-exosomes show an ability to promote autophagy in chondrocytes through mTOR inhibition, in addition to reducing the mTOR luciferase activity. The ability of DPSC-exosomes to partially regulate autophagy was blocked upon inhibition of miR-31. In brief, DPSC-exosomes have a chondroprotective role in a mouse osteoarthritis model. The underlying mechanism is possibly related to miR-31-mediated suppression of the mTOR-autophagy pathway.

Systemic lupus erythematosus (SLE) can adversely affect surgical outcomes, and the impact on revision total knee arthroplasty (TKA) outcomes is unclear. This study aimed to explore the impact of SLE on in-patient outcomes of revision TKA. The Nationwide Inpatient Sample (NIS) database from 2005 to 2018 was searched for patients aged ≥ 18 years old who received revision TKA. Patients with and without SLE were propensity score matched (PSM) at a 1:4 ratio. Associations between SLE and in-hospital outcomes were examined using regression analyses. The study included 133,054 patients, with 794 having SLE. After 1:4 PSM, data of 3,970 patients were analyzed (SLE, 794; non-SLE, 3,176). Multivariate-adjusted analyses revealed that SLE patients had a significantly higher risk of postoperative complications (adjusted odds ratio [aOR] = 1.23, 95

PurposeThe present study is aimed at investigating whether (1) primary tumour surgery confers an improved survival on patients with metastatic osteosarcoma and (2) primary tumour surgery influences survival of patients with metastatic osteosarcoma differently according to primary tumour site.MethodsWe retrospectively identified 517 patients with high-grade, metastatic osteosarcoma in the Surveillance, Epidemiology, and End Results (SEER) database between 1994 and 2013. The effect of primary tumour surgery on survival was assessed using Kaplan-Meier analyses, log-rank tests, and multivariate Cox proportional hazard regression modeling.ResultsOf those 517 patients with metastatic osteosarcoma in the cohort, 351 patients (68%) underwent primary surgery, and 166 patients (32%) did not undergo surgery. Primary tumour surgery was associated with increased overall survival (hazard ratio (HR)=0.457, 95% CI 0.354-0.590, p<0.001) and cancer-specific survival (HR=0.422, 95% CI 0.325-0.550, p<0.001). When we focused on different primary tumour sites, receipt of primary tumour surgery significantly prolonged the survival of patients with extremity osteosarcoma (p<0.05 for overall and cancer-specific survival). However, for patients with pelvis/spine osteosarcoma, both univariate and multivariate analyses indicated that primary tumour surgery might not be associated with improved survival (p>0.05 for overall and cancer-specific survival).ConclusionsOur study is the first population-based analysis to provide evidence of a favourable prognostic impact of primary tumour surgery on metastatic extremity osteosarcoma patients but not metastatic axial (pelvis/spine) osteosarcoma patients. Moreover, we found that surgery type (resection of the primary tumor without amputation vs. amputation) did not influence survival in patients with metastatic osteosarcoma.

BACKGROUND:Osteosarcoma (OS) immune environment is complexed and the immune factors-related to OS progression need to be explored. Tumor-associated macrophages (TAMs) are regarded as immune suppressive and tumor-promoting cells. However, the underlying mechanisms through which TAMs function are still fragmentary. Here, we aim to explore the underlying mechanisms by which TAMs regulate OS progression.METHODS:TAMs from OS tissues were isolated by flow cytometry. Exosomes derived from TAMs were separated using ultracentrifugation and western blotting. Transmission electron microscopy (TEM), and flow cytometry were constructed to characterize TAMs-derived exosomes. Additionally, the differential MicroRNAs (miRNAs) and genes were detected through RNA sequencing, and further validated using real-time PCR (RT-PCR). OS cell metastasis ability was assessed using transwell invasion and scratch wound healing assays. MiRNAs mimic and lentiviral vectors were utilized to explore the effects on OS progression.RESULTS:Exosome secreted by TAMs accelerated the OS metastasis. Let-7a level was upregulated in TAMs derived exosomes, which downregulated C15orf41 by targeting 3'-untranslated region (UTR). Furthermore, overexpressing let-7a enhanced invasion and migration by blocking the transcription of C15orf41. In consistent, up-regulating let-7a promoted OS progression and made the prognosis to be worse, which can be reversed by C15orf41 overexpression.CONCLUSION:This study highlighted the critical role of TAMs-derived exosomes in OS progression and explored the potential value of the let-7a/C15orf41 axis as an indicator or target for OS.

Abstract Background This study was aimed to investigate whether the application of platelet-rich plasma (PRP) combined with β-tri-calcium phosphate (β-TCP) grafts after core decompression (CD) could improve the clinical outcomes of early stage of avascular necrosis of femoral head. Methods Forty-five (54 hips) patients with Ficat-Arlet classification stage I-II treated by CD with β-TCP grafts with or without the application of PRP from July 2015 to October 2020 were reviewed. Group A (CD + β-TCP grafts) included 24 patients (29 hips), while group B (CD + β-TCP grafts + PRP) included 21 patients (25 hips). Visual analogue scale (VAS) score, Harris hip score (HHS), change in modified Kerboul angle and the hip joint survival were evaluated and compared between the groups. Patients had a mean follow-up period of 62.1 ± 17.2 months and 59.3 ± 14.8 months in group A and group B, respectively. Results The mean VAS scores in group A was significantly higher than group B at the 6 months (2.9 ± 0.7 vs 1.9 ± 0.6, p < 0.01) and final follow up postoperative (2.8 ± 1.2 vs 2.2 ± 0.7, p = 0.04). The mean HHS in group A was significantly lower than group B at the 6 months (80.5 ± 13.8 vs 89.8 ± 12.8, p = 0.02). However, at the final follow up, there is no significant difference between the groups (77.0 ± 12.4 vs 83.1 ± 9.3, p = 0.07). The mean change in modified Kerboul angle was -7.4 ± 10.6 in group A and -19.9 ± 13.9 in group B which is statistically significant (p < 0.01). Survivorship from total hip arthroplasty were 86.2%/84% (p = 0.86) at the final follow up, which was not statistically significant. No serious complications were found in both groups. Conclusions A single dose of PRP combined with CD and β-TCP grafts provided significant pain relief, better functional outcomes, and delayed progression in the short term compared to CD combined with β-TCP grafts. However, the prognosis of the femoral head did not improve significantly in the long term. In the future, designing new implants to achieve multiple PRP injections may improve the hip preservation rate.

Purpose The study is aimed at investigating the association between different reduction classifications (anatomic reduction, positive buttress position reduction, and negative buttress position reduction) and two end points (complications and reoperations). Methods The study retrospectively analyzed 110 patients undergoing internal fixation with three parallel cannulated screws from January 2012 to January 2019 in Huashan Hospital. Based on the principles of the “Gotfried reduction,” all enrolled patients were divided into three groups: anatomic reduction, positive buttress position reduction, and negative buttress position reduction intraoperatively or immediately after surgery. Clinical characteristics including age, sex, side, Garden classification, Pauwels classification, fracture level, reduction classification, Garden alignment index angles, cortical thickness index (CTI), tip-caput distance (TCD), angle of the inferior screw, and the two ending points (complications and reoperations) were included in the statistical analysis. The Mann-Whitney U-test, the chi-square test, Fisher's exact test, and multiple logistic regression analysis were used in the study. Results Of the 110 patients included in our study, the mean ± standard deviation (SD) of age was 51.4 ± 10.4 years; 41 patients showed anatomic reduction, 35 patients showed positive buttress position reduction, and 34 patients showed negative buttress position reduction. For the outcomes, 24 patients (anatomic reduction: 6 [14.6%]; positive buttress position reduction: 5 [14.3%]; negative buttress position reduction: 13 [38.2%]) had complications, while 18 patients (anatomic reduction: 5 [12.2%]; positive buttress position reduction: 3 [8.6%]; negative buttress position reduction: 10 [29.4%]) underwent reoperations after surgery. In the multivariate logistic regression analysis of complications, negative buttress position reduction (negative buttress position reduction vs. anatomic reduction, OR = 4.309, 95%CI = 1.137 to 16.322, and p = 0.032) was found to be correlated with higher risk of complications. The same variable (negative buttress position reduction vs. anatomic reduction, OR = 5.744, 95%CI = 1.177 to 28.042, and p = 0.031) was also identified as risk factor in the multivariate logistic regression analysis of reoperations. However, no significant difference between positive reduction and anatomical reduction was investigated in the analysis of risk factors for complications, not reoperations. Conclusion Positive buttress position reduction of femoral neck fractures in young patients showed a similar incidence of complications and reoperations compared with those of anatomic reduction. For irreversible femoral neck fractures, if positive buttress position reduction has been achieved intraoperatively, it is not necessary to pursue anatomical reduction; however, negative reduction needs to be avoided.

Purpose The aim of this study is to investigate the prognostic value of tibial component coverage (over-hang and under-hang) and the alignment of total knee arthroplasty (TKA) components 1 week after surgery. We select patient-reported outcome measures (PROMS) (the Knee Society score (KSS score) and the Western Ontario and McMaster Universities Osteoarthritis Index-pain score (WOMAC pain score)) and tibial bone resorption (TBR) 2 years after surgery as the end points. Methods The study retrospectively analyzed 109 patients undergoing TKA (fixed-bearing prosthesis with asymmetrical tibial tray) from January 2014 to December 2017 in Huashan Hospital. By using standard long-leg X-rays, anteroposterior (AP) and lateral X-rays of the knee, tibial component coverage (under-hang or over-hang), AP tibial-femoral anatomical angle (AP-TFA), AP femoral angle (AP-FA), AP tibial angle (AP-TA), and lateral tibial angle (L-TA) were measured at 1 week after surgery, while TBR was measured through postoperative 1-week and 2-year AP and lateral radiographs of the knee on three sides (medial side, lateral side on AP radiograph, and anterior side on lateral radiograph). The Pearson correlation analysis, simple linear regression, multiple linear regression, the Student’s t test, and one-way ANOVA together with Tukey’s post hoc test (or Games-Howell post hoc test) were used in the analyses. Results Tibial under-hang was more likely to appear in our patients following TKA (42%, medially, 39%, laterally, and 25%, anteriorly). In multivariate linear regression analysis of TBR, tibial under-hang (negative value) 1 week after surgery was positively correlated with TBR 2 years later on the medial ( p = 0.003) and lateral ( p = 0.026) side. Tibial over-hang (positive value) 1 week after surgery on the medial side was found negatively related with KSS score ( p = 0.004) and positively related with WOMAC pain score ( p = 0.036) 2 years later in multivariate linear regression analysis of PROMS. Both scores were better in the anatomically sized group than in the mild over-hang group (or severe over-hang) ( p < 0.001). However, no significant relationship was found between the alignment of TKA components at 1 week after surgery and the end points (TBR and PROMS) 2 years later. Conclusion Under-hang of the tibial component on both the medial and lateral sides can increase the risk of TBR 2 years later. Over-hang of tibial component on the medial side decreases the PROMS (KSS score and WOMAC pain score) 2 years later. An appropriate size of tibial component during TKA is extremely important for patient’s prognosis, while the alignment of components might not be as important.

Objective:To explore the clinical characteristics of artificial femoral head replacement with SuperPATH approach under the enhanced recovery after surgery (ERAS) concept for the treatment of femoral neck fractures in the elderly, and analyze the clinical benefits and medical risks of this model.Methods:A prospective data collection of 80 elderly patients with femoral neck fractures treated with artificial femoral head replacement via SuperPATH approach, including 40 cases of ERAS and 40 conventional rehabilitation cases were collected, and the gender, age, preoperative score, comorbidities, hemoglobin level, blood loss, blood transfusion rate, complication rate, length of hospital stay, Harris score, independent walking ability and EQ-5D score of the two groups were compared.Results:All the 80 patients were followed up completely, and the follow-up rate was 100%. The follow-up time ranged from 3 to 36 months, with an average of (15±7) months. The follow-up time of ERAS group ranged from 3 to 31 months, with an average of (14±7) months. The follow-up time of the conventional rehabilitation group was from 3 to 34 months, with an average of (16±7) months. The ages of the patients in the ERAS group and the conventional rehabilitation group were 81±5 years and 81±4 years, respectively. The patients in the two groups with medical complications were 95% and 97.5%, respectively. There were no significant differences between the two groups in indicators such as gender, age, comorbidities, ASA classification, preoperative walking ability and cognitive status (P>0.05). The intraoperative blood loss, total blood loss, allogeneic blood transfusion rate, postoperative complications and hospital stay in the ERAS group were significantly reduced compared with the conventional group (P<0.05). The incidence of postoperative complications in the ERAS group and the conventional rehabilitation group were 25.0% and 47.5, respectively, and the hospital stay in both groups was more than 10 days. There was no significant difference in Harris score, independent walking ability and 2-year overall survival rate (Kaplan-Meier curve) between the two groups at 12 months after surgery (P>0.05).Conclusion:Under the ERAS concept, SuperPATH artificial femoral head replacement can speed up recovery, but the perioperative complication rate is still high, and the hospital stay is longer. The treatment of elderly femoral neck fractures with more comorbidities needs to emphasize the patient-centered approach and focus on individualized treatment of all aspects of ERAS, so as to increase the speed and to ensure the quality.

Articular cartilage injuries are common orthopedic conditions that severely affect the quality of life of patients. Tissue engineering can facilitate cartilage repair and the key points involve scaffolding and seed cell selection. Pre-experiments found a range of microstructures of bioceramic scaffolds suitable for chondrocyte adhesion and proliferation, and maintaining chondrocyte phenotype. Three-dimensional cultures of bone marrow mesenchymal stem cell (BMSC) scaffolds were implanted into mice. According to the shape of the bioceramic scaffolds and the implantation time in vivo, RNA sequencing was performed on the removed scaffolds to explore the molecular mechanism. The in vitro bone plate culture can induce differentiation of chondrocytes, making culture different to that produced in vitro. Implantation of scaffolds in vivo increases the expression of bone-related genes. The ceramic rod-like material was found to be superior to the disc shape, and the bone repair effect was more marked with longer implantation times. Gene Ontology analysis revealed that 'cell chemotaxis', 'negative regulation of ossification' and 'bone development' pathways were involved in recovery. It was further confirmed that BMSCs were suitable as seed cells for cartilage tissue engineering, and that the beta -tricalcium phosphate scaffold maybe ideal as cartilage tissue engineering scaffold material. The present research provided new insights into the molecular mechanism of cartilage repair by BMSCs and bioceramic scaffolds. Bioinformatics analysis revealed that AMMECR1L-like protein, tumor necrosis factor-induced protein 2, inhibitor of nuclear factor-B kinase subunit and protein kinase C type and 'negative regulation of ossification' and 'bone development' pathways may be involved in osteoblast maturation and bone regeneration.

目的 旨在开发预后列线图来预测四肢骨肉瘤患者的生存率.方法 回顾分析1995年至2014年,1910例四肢骨肉瘤患者(来自SEER数据库),通过单因素Log-rank分析和多因素COX分析找出存在统计学差异的预后因素,使用相应的预后因素构建列线图,进而对患者1、3、5年的总生存期(overall survival,OS)和癌症特异性生存期(cancer-specific survival,CSS)进行预测.然后对列线图进行内外部验证,并且通过使用C指数为量化指标来计算模型的准确性.结果 单因素和多因素分析显示肿瘤确诊年龄、分期、手术状态、大小和病理类型与患者的OS和CSS显著相关.基于这些预后指标,构建能够预测患者的1、3、5年OS和CSS的列线图.对该列线图进行内外部验证,发现该列线图均具有较好的C指数,其中在内部验证中,OS为0.721,CSS为0.712;外部验证中,OS为0.681,CSS为0.683.在内外部验证中,列线图的校准图显示了骨肉瘤患者的实际存活率和该列线图预测结果 之间有着良好的一致性.结论 骨肉瘤确诊年龄、分期、手术状态、大小和病理类型与患者的OS和CSS显著相关.四肢骨肿瘤患者OS和CSS的列线图,可较为准确地估计四肢骨肉瘤患者1、3、5年的OS和CSS,进而帮助临床医生更快、更可靠的做出临床预测.

Abstract Background Several studies have been conducted to report diagnostic values of the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) in the many diseases, such as oncological, inflammatory, and some infectious diseases. However, the predictive value of these laboratory parameters for early periprosthetic joint infections (PJIs) has not yet been reported. The aim of this study was to determine predictive values of the postoperative NLR, PLR, and LMR for the diagnosis of PJIs. Methods In this retrospective study, 104 patients (26 early PJI cases and 78 non-PJI cases) who underwent total joint arthroplasty were enrolled in this study. All the patients were then categorized into two groups: PJI group, patients with the diagnosis of PJI (26 patients; 14 males, 12 females; mean age = 65.47 ± 10.23 age range = 51–81 ) and non-PJI group, patients without PJI (78 patients; 40 males, 38 females; mean age = 62.15 ± 9.33, age range = 41–92). We defined “suspected time” as the time that any abnormal symptoms or signs occurred, including fever, local swelling, or redness around the surgical site between 2 and 4 weeks after surgery and before the diagnosis. Suspected time and laboratory parameters, including NLR, PLR, LMR, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP), were compared between both groups. The trends of postoperative NLR, LMR, PLR, CRP, and ESR were also reviewed. The predictive ability of these parameters at the suspected time for early PJI was evaluated by multivariate analysis and receiver operating characteristic (ROC) curve analysis. Results NLR, PLR, and LMR returned to preoperative levels within 2 weeks after surgery in the two groups. In the PJI group, NLR and PLR were significantly increased during the incubation period of infection or infection, and LMR was significantly reduced, although 61.5% (16/26) of the patients had normal white blood cells. Interestingly, ESR and CRP were still relatively high 2 weeks after surgery and were not different between the two groups before infection started (p = 0.12 and 0.4, respectively). NLR and PLR were significantly correlated with early PJI (Odds ratios for NLR and PLR = 88.36 and 1.12, respectively; p values for NLR and PLR = 0.005 and 0.01, respectively). NLR had great predictive ability for the diagnosis of early PJI, with a cut-off value of 2.77 (sensitivity = 84.6%, specificity = 89.7%, 95% CI = 0.86–0.97). Conclusions ESR and CRP seem not to be sensitive for the diagnosis of early PJI due to their persistently high levels after arthroplasty. The postoperative NLR at the suspected time may have a great ability to predict early PJI.

In order to study the expression of lysine-specific demethylase 6B, Kdm6b in differentiation of chondrocyte and chondrogenesis and the regulation effect of Kdm6b on chondrocyte anabolism, a mouse model of osteochondral defects was established in this study. The mice were subjected to antibiotic treatment and intestinal microbiota reconstruction by the method of specific knock out Kdm6b of embryonic cartilage. The mice were divided into Col2al-CreER Kdm6b experimental group and Kdm6b control group and then the destabilization of the medial meniscus operation was performed to model osteoarthritis in mice, which accelerated the abnormal metabolism of cartilage. In addition, transgenic mice with induced chondrocyte specific knockout of Kdm6b were constructed and embryonic samples were collected to study the effects of Kdm6b knockout on cartilage development. At the same time, the proliferation and apoptosis of chondrocytes after kdm6b gene knockout were also studied based on the obvious abnormalities in embryonic chondrogenesis. The results showed that 3 weeks after the mouse osteochondral defect modelling surgery, the mice in the Col2al-CreER; Kdm6b group still had an area without complete healing in the femoral trochle defect, while the defect areas in the Kdm6b group of mice were completely filled. After 12 weeks of mouse osteoarthritis modelling, mice in the Kdm6b group showed cartilage staining loss and cartilage defect. The mice in the Col2al-CreER Kdm6b group were more severe, and even a large area of wear and destruction of the cartilage layer appeared. However, after the growth plate thickness of mice in the Col2al-CreER Kdm6b group was observed, it was found that there was no statistical significance compared with the Kdm6b control group. qRT-PCR analysis showed that compared with the Kdm6b control group, the Col10al gene expression in the primary chondrocytes of the Col2a1-CreER Kdm6b group was significantly decreased. In addition, qRT-PCR and Western Blot sequencing verified that the expressions of Sox9, Col2al, Acan and other proteins related to anabolism were significantly reduced after Kdm6b knockout. Therefore, it can be concluded that Kdm6b directly regulated the expression of genes related to chondrocyte anabolism, and Kdm6b knockout could inhibit the anabolism of chondrocytes, impair the synthesis of cartilage matrix, and accelerate the progress of osteoarthritis.

Objective : The purpose of this study was to evaluate the predictive value of the postoperative neutrophil-to-lymphocyte ratio on early periprosthetic joint infection. Methods : During the period from January 2008 to December 2016, 104 patients (26 early PJI cases and 78 non-PJI cases) who underwent total joint arthroplasty in the department of orthopedics in our Hospital were enrolled in our study. All of the relevant clinical information and laboratory indexes were reviewed from the our Hospital Follow-up system. The time when any abnormal symptoms or signs occurred including fever, local swelling or redness around the surgical site 2 weeks after the operations was defined as the “suspect time”. We compared the laboratory parameters including the NLR 、PLR、LMR、ESR and the CRP between the two groups. The trend of the NLR、LMR、PLR、CRP and ESR were also reviewed after the surgery. The predictive ability of these parameters at suspect time on the early PJI were evaluated by multivariate analysis and the Receiver operating curve analysis (ROC). Results : NLR, PLR and LMR returned to preoperative level within two weeks in two groups after surgery. In the early PJI group, NLR and PLR were significantly increased during the incubation period of infection or infection, LMR was significantly reduced, although 61.5% (16/26) of the patients had normal white blood cell. Interesting, the ESR and CRP were still in relative high level two weeks after the operation and the change of these two indexes was not obvious when the infection occurs. The NLR and PLR was significantly correlated with the early PJI (OR NLR =88.36, OR PLR =1.12, P NLR =0.005, P PLR =0.01) and the NLR has a great predict ability for early PJI with the cut-off value 2.77 (Sensitivity=84.6% ，Specificity=89.7%, 95% CI=0.86-0.97) Conclusions: ESR and CRP are not sensitive for diagnosis of early PJI due to their persistent high level after arthroplasty. The postoperative NLR at suspect time have a great ability in predicting early PJI and more attention should be applied to it.

Objective:To investigate the role of norcantharidin (NCTD) in cells viability, invasive ability and inducing apoptosis of giant cell tumor of bone (GCTB) in vitro and its related mechanisms.Methods:Three cases of intraoperative tumor tissue specimens of GCTB (Campanacci Grade Ⅱ) patients in Huashan hospital were collected from January 2018 to March 2019, including 2 males (35 years old and 40 years old) and 1 female (27 years old). The primary GCTB cells were isolated, cultured and identified in vitro. The GCTB cells were divided into negative control group (0 μg/mL) and NCTD intervention group (200 μL of 5, 10, 20, 40 μg/mL NCTD solution was added in each well). After 24 h intervention, the cell morphology of each group was observed under microscope and the cells viability of each group were detected using CCK-8. Then GCTB cells were divided into control group, 5 μg/mL NCTF group and 20 μg/mL NCTD group. Transwell assay was used to detect cell invasive ability of each group. Flow cytometry was applied to evaluate the apoptosis rate of each group. The enzyme activity of caspase-3/cleaved-caspase-3 and caspase-9/cleaved caspase-9 were detected by commercial kit. JC-1 and DHE staining was used to assess the mitochondrial membrane potential and the level reactive oxygen species (ROS) in GCTB cells. Finally, the expression of apoptosis-related proteins cleaved caspase3, caspase-3, cleaved caspase9, caspase-9, Bcl-2-associatedx(Bax) and B-cell leukemia-lymphoma(Bcl-2) were measured by western blot.Results:The GCTB tissue samples were isolated and cultured in vitro. Most of cells were irregular stromal cells after passaging. The expression of CD68 around the nucleus were positive, suggesting that the cells were giant cell tumor cells. Under microscopic observation, the cells shrank, suspended and gradually 25 lost their original morphology with the increase of NCTD concentration. CCK-8 results showed that the survival rates of GCTB cells in each group (5, 10, 20, 40 μg/mL) were 100%, 76.45%±9.86%, 62.34%±10.21%, 39.74%±8.36%, 25.54%±7.18%, respectively. The cell survival rate decreased gradually with the increase of the NCTD concentration, and the difference was statistically significant( F=75.716, P<0.05). Transwell test showed that the proportion of invasive cells in each group was 49.33%±9.84%, 32.84%±2.73%, 8.34%±1.41%, respectively ( F=36.034, P<0.01). There were significantly different apoptosis rates among the control group, 5 μg/mL and 20 μg/mL group (4.73%±0.05%, 14.23%±0.85%, 51.21%±10.47%, respectively, F=49.183, P<0.01). The activities of cleaved-caspase-3/9 were gradually increased from the control group to 20 μg/mL NCTD group, and the difference was statistically significant ( F=15.223, 30.841, all P values<0.01). The level of ROS level in GCTB cells was significantly increased with the increase of NCTD concentration in the control group, 5μg/mL NCTD group and 20 μg/mL NCTD group. The mitochondrial membrane potential levels were detected in all of three groups. The values in control group, 5, 20 μg/mL NCTD group were 2.01±0.11, 1.27±0.07 and 0.79±0.14, respectively ( F=128.641, P<0.01). The results of Western blot suggested that the relative expression of cleaved-caspase-3/9 and Bax increased, while the expression of Bcl-2 was decreased with the increase of NCTD concentration. There was a statistically significant difference between three groups (all P values<0.01). However, there was no significant change in the expression level of caspase-3 and caspase-9 (all P values>0.05). Conclusions:NCTD can significantly inhibit the activity of GCTB cells in vitro, increase cell invasion and promote the apoptosis of GCTB cells. Its mechanism may be related to reducing the mitochondrial membrane potential, increasing the level of cellular reactive oxygen species, and regulating the expression of apoptosis-related proteins.

Background The current research used a new index—adipose to muscle area ratio (AMR)—to measure fatness compared with body mass index (BMI) in elderly osteoarthritis (OA) patients following total knee arthroplasty. Our study aimed to test the relationship between the two indexes (AMR and BMI) and to examine whether AMR was a predictive factor of patient-reported outcome measures (PROMS) for elderly OA patients following total knee arthroplasty (TKA). Methods The retrospective data of 78 OA patients (older than 60 years) following TKA was included in our study. Clinical features of patients included age, BMI, sex, AMR, side of the implant, time of follow-up, complications, the Knee Society Score (KSS score), and the Hospital for Special Surgery knee score (HSS score). The area of adipose tissue and muscle tissue was measured on the cross section (supra-patella, midline of the patella, joint line of the knee) of the knee magnetic resonance imaging (MRI). AMR was calculated as the average of adipose to muscle area ratio at the three levels. The Pearson correlation analysis, simple linear regression, and multiple linear regression were used to study the relationship between BMI, AMR, and PROMS (KSS total-post score and HSS-post score) in the study. Results Of all patients, the mean (± standard deviations (SD)) of age was 67.78 ± 4.91 years. For BMI and AMR, the mean (± SD) were 26.90 ± 2.11 and 2.36 ± 0.69, respectively. In Pearson correlation analysis, BMI had a good correlation with AMR ( r = 0.56, p = 0.000), and AMR ( r = − 0.37, p = 0.001, HSS-post score; r = − 0.43, p = 0.000, KSS total-post score) had better correlations with PROMS postoperatively compared with BMI ( r = − 0.27, p = 0.019, HSS-post score; r = − 0.33, p = 0.003, KSS total-post score). In multivariate linear regression analysis, AMR was negatively correlated with KSS total-post score as well as HSS-post score, while BMI was not. As for patients with complications, AMR values were between the 3rd quartile and 4th quartile of the AMR value in the entire study cohort. Conclusions In this study, the new obesity evaluation indicator—AMR, which was well related with BMI, was found to be a predictor of PROMS (KSS total-post score and HSS-post score) in elderly OA patients following TKA.

Abstract Background： The purpose of this study was to evaluate the predictive value of the postoperative neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and lymphocyte-to-monocyte ratio (LMR) for early periprosthetic joint infection (PJI). Methods : During the period from January 2008 to December 2016, 104 patients (26 early PJI cases and 78 non-PJI cases) who underwent total joint arthroplasty at the Department of Orthopedics in our hospital were enrolled in this study. All of the relevant clinical information and laboratory indexes were reviewed from our hospital follow-up system. The time when any abnormal symptoms or signs occurred, including fever, local swelling or redness around the surgical site between the 2nd and 4th weeks after surgery, was defined as the “suspect time”. We compared laboratory parameters, including NLR, PLR, LMR, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), between the two groups. The trends of NLR, LMR, PLR, CRP and ESR were also reviewed after surgery. The predictive ability of these parameters at the suspect time for early PJI was evaluated by multivariate analysis and receiver operating characteristic (ROC) curve analysis. Results : NLR, PLR and LMR returned to preoperative levels within two weeks after surgery in the two groups. In the early PJI group, NLR and PLR were significantly increased during the incubation period of infection or infection, and LMR was significantly reduced, although 61.5% (16/26) of the patients had normal white blood cells. Interestingly, ESR and CRP were still relatively high two weeks after surgery, and the change in these two indexes was not obvious when infection occurred. NLR and PLR were significantly correlated with early PJI (Odds ratio (OR) N LR =88.36, OR PLR =1.12, P NLR =0.005, P PLR =0.01), and NLR had great predictive ability for early PJI, with a cut-off value of 2.77 (sensitivity=84.6%, specificity=89.7%, 95% CI=0.86-0.97) . Conclusions: ESR and CRP are not sensitive for the diagnosis of early PJI due to their persistently high levels after arthroplasty. The postoperative NLR at the suspected time has a great ability to predict early PJI, and more attention should be paid to it.

目的初步探讨3D打印金属垫块在全膝关节置换（total knee arthroplasty,TKA）术中重建胫骨平台缺损的可行性。方法在尸体标本上进行内侧胫骨平台骨缺损造模（AORIⅡ型）,作为垫块组,另一侧膝关节不做处理,作为对照组;双侧膝关节经CT扫描后利用Mimics等有限元分析软件,重建骨缺损模型并设计金属垫块,在SolidWorks软件中与胫骨和胫骨平台模块进行装配。通过模拟人体行走时的受力情况,在胫骨平台上施加2 000 N的纵向应力,绘制Mises应力云图和Logarithmic应变云图,分析两组模型的胫骨平台上的应力分布;在三维模型的各模块上选择2个观察点,通过分析其受力前后在三维空间中的位移和转角,计算各部分组件的位移和旋转,从而探讨其初始稳定性。结果垫块组的胫骨平台承力区域较对照组小,应力增大,并且应力变化没有对照组平缓。其中,垫块组胫骨平台上、下表面应力集中区域的应力代表值约为0.65和0.75 MPa;对照组则为0.71和0.95 MPa。两组应力较大值的集中区域相同。垫块组中胫骨和胫骨平台在3个方向的位移均略小于对照组;垫块组的胫骨平台和胫骨的内/外翻角度稍大,而前/后倾及内外旋均小于对照组,两组模型中3D金属块本身的位移和旋转角度均非常小,且在安全范围内。结论 3D打印金属垫块对于TKA术中胫骨平台骨缺损的修复具有良好的应用前景。

An increasing number of patients with hepatitis B virus (HBV) infection are undergoing total joint arthroplasty (TJA) surgery in China. Less attention is provided to the special populations and the purpose of this study is to assess the effect of HBV infection on the prognosis TJAs. We retrospectively reviewed patients who underwent elective primary hip and knee arthroplasties in Shanghai Huashan Hospital from 2013 to 2016. Non-hepatitis B cohort was built to match the case cohort to identify whether HBV infection was a risk factor associated with postoperative complications. A total number of 196 patients who underwent primary TJAs were involved in the study, including 49 patients with hepatitis B and 147 non-hepatitis B subjects. Among all the patients with TJAs, 5.5% of patients were infected with HBV for the first time. The incidence rate of complications in patients after arthroplasty with hepatitis B infection was significantly higher than that in patients without hepatitis B (10.2% compared to 4.7%, P < 0.01). Surgical related complications (6.1% compared to 3.4%) and general medical complications (4.1% compared to 1.3%) were higher than those in non-B hepatitis group. Compared with non-B hepatitis group, the overall risk of hepatitis B infection increased by 25% (95% CI, 1.04–1.46; p < 0.01). Similar results were obtained for medical and surgical complications. HBV infection presented a 31% increased risk (95% CI, 1.02–1.62; p < 0.01) for medical complication and an 18% increased risk (95% CI, 1.10–1.26; p < 0.01) for surgical complication. No statistical difference was found between the surgical methods and sex. However, a significant difference of C-reactive protein (CRP) level was found between HBV infection group and the matched non-infected group (P < 0.01). This is the first study to investigate the risk of perioperative complications of hepatitis B in Chinese TJAs patients. In consideration of the large population of HBV infection in China, more attention and medical care should be provided to patients with HBV infection who need to undergo TJA operation.

Objective To compare overall survival of metastatic extremity patients treated with limb salvage and amputation. Methods Fifty-eight patients of extremity chondrosarcoma with distant metastasis were collected between 1994 and 2013 from Surveillance, Epidemiology, and End Results (SEER) database for retrospective analyses. All the patients were classified as limb salvage group ( n =43) or amputation group (n=15) according to surgery type. Univariate Log-rank analysis and multivariate Cox proportional hazard regression analysis were applied to compare overall survival in these two groups. Results Among 58 extremity chondrosarcoma patients, 33 patients were males, 25 patients were females, and the median age was 61(14 -88 years old). Of the patients in the cohort, 16 patients had a tumor located in upper extremity, while 42 patients had a tumor located in lower extremity. There was no significant difference in overall survival between patients treated with limb salvage and amputation ( P=0. 409) by univariate log-rank analysis demonstrated. In addition, multivariate Cox regression analysis including surgery type, histologic subtype and tumor grade was performed to control confounding variables. The results of multivariate analysis still suggested that there was no difference in overall survival between patients treated with limb salvage and amputation (amputation: hazard ration=1. 646, 95% confidence interval=0. 856-3. 166, P >0. 05). Conclusions There is no significant difference in overall survival between patients treated with limb salvage and amputation.

BACKGROUND:Several methods are available for the treatment of early-stage osteonecrosis of the femoral head. Core decompression with implantation is a widely-used treatment. However, no single implant is recognized as the most effective way to prevent disease progression. Silk has high strength and resiliency. This study explored the possibility of a strong and resilient silk protein biomaterial as a new alternative implant. METHODS:We investigated the biomechanical properties of the silk protein material by regular compression, torsion, and three-point bending tests. We established three-dimensional finite element models of different degrees of femoral head osteonecrosis following simple core decompression, fibula implantation, porous tantalum rod implantation, and silk protein rod implantation. Finally, we compared the differences in displacement and surface stress under load at the femoral head weight-bearing areas between these models. RESULTS:The elastic modulus and shear modulus of the silk protein material was 0.49GPa and 0.66GPa, respectively. Three-dimensional finite element analyses demonstrated less displacement and surface stress at the femoral head weight-bearing areas following silk protein rod implantation compared to simple core decompression (p < 0.05), regardless of the extent of osteonecrosis. No differences were noted in the surface deformation or surface stress of the femoral head weight-bearing areas following silk protein rod, fibula or tantalum rod implantation (p > 0.05). CONCLUSIONS:When compared with simple core decompression, silk protein rod implantation demonstrated less displacement and surface stress at the femoral head weight-bearing area, but more than fibula or tantalum rod implantation. Similar effects on the surface stress of the femoral head between the silk rod, fibula and tantalum rod implantations, combined with additional modifiable properties support the use of silk protein as a suitable biomaterial in osteonecrosis surgery.