BACKGROUND:We sought to: (1) develop a new method in measuring spino-pelvic tilt (SPT) from antero-posterior pelvic (AP pelvis) radiographs and computed tomography scans, and examine its reliability and validity; (2) use Z-scores to evaluate patients' SPT based on an established asymptomatic norm; and (3) examine whether a compensatory mechanism of anterior pelvic tilt exists for borderline hips, denoted as differences in anterior wall indices both between standing and supine positions, and between borderline hip dysplasia (BHD) patients and asymptomatic norms. METHODS:After the inclusion and exclusion criteria, 24 patients were finally included. Patients who had unilateral or bilateral borderline hips were included. A supine computed tomography scan, standing AP pelvis, and standing full spine radiograph were obtained. Digitally reconstructed radiographs with various SPTs were generated. Regression models were fitted to predict SPT for standing AP pelvis, and subsequently to calculate Z-scores based on an established asymptomatic norm. Wilcoxon signed rank tests were applied to test the deviation of SPT from the asymptomatic norm. Generalized estimating equations were used to model Z-scores for SPT and between-position/between-population anterior acetabular coverage. RESULTS:The SPT prediction had excellent reliability with intraclass correlation coefficient > 0.99 (0.99 to 1.00) and interobserver reliability with intraclass correlation coefficient > 0.99 (0.99 to 1.00). The mean Z-score was -1.09 (0.94), and its difference from zero was statistically significant (P < 0.001). The generalized estimating equation modeling reveals a negative correlation between SPT and anterior acetabular coverage compensation, denoted as differences in anterior wall indices, both between standing and supine in BHD patients and between standing BHD patients and the standing asymptomatic norm. CONCLUSIONS:Patients who have BHD have greater anterior pelvic tilt compared with the asymptomatic norm. Anterior acetabular coverage may be overestimated on the standing AP pelvis for BHD patients.

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

Objectives: Whether the application of MBP plus cannulated screws works for old femoral neck fractures(OFNF) is unknown.The purpose of this study is to present a case series of OFNF in young adults using calcar buttress plate and three cannulated screws with autologous iliac bone grafts.Methods: We conducted a retrospective study of eleven young patients (6 males and 5 females) with femoral neck fractures who were treated with open reduction and internal fixation at a single center between 2013 and 2021. The subjects had trauma-to-surgery intervals longer than 3 weeks and all were fixed with a calcar buttress plate combined with three cannulated screws, which were supplemented by autologous iliac bone grafts.Results: All eleven cases achieved radiological union under the surgery technique, which occurred on average at 4.46±1.29 months after surgery. Complications included femoral neck shortening in all cases, heterotopic ossification in three cases, and osteonecrosis of the femoral head in two cases. One patient with osteonecrosis of the femoral head received total hip arthroplasty. In follow-ups of 24-52 months, the median Harris hip score was 81.64±15.39.Conclusions: The medial buttress plate in combination with three cannulated screws and iliac autograft may be a good choice for treating old femoral neck fractures in young adults.Level of evidence IV, case series.

Osteoarthritis (OA) progression is highly associated with chondrocyte mitochondrial dysfunction and disorders of catabolism and anabolism of the extracellular matrix (ECM) in the articular cartilage. The mitochondrial unfolded protein response (UPRmt), which is an integral component of the mitochondrial quality control (MQC) system, is essential for maintaining chondrocyte homeostasis. We successfully validated the pivotal role of activating transcription factor 5 (ATF5) in upregulating the UPRmt, mitigating IL-1β-induced inflammation and mitochondrial dysfunction, and promoting balanced metabolism in articular cartilage ECM, proving its potential as a promising therapeutic target for OA. Modified mRNAs (modRNAs) have emerged as novel and efficient gene delivery vectors for nucleic acid therapeutic approaches. In this study, we combined Atf5-modRNA (modAtf5) with engineered exosomes derived from bone mesenchymal stem cells (ExmodAtf5) to exert cytoprotective effects on chondrocytes in articular cartilage via Atf5. However, the rapid localized metabolization of ExmodAtf5 limits its application. PLGA-PEG-PLGA (Gel), an injectable thermosensitive hydrogel, was used as a carrier of ExmodAtf5 (Gel@ExmodAtf5) to achieve a sustained release of ExmodAtf5. In vitro and in vivo, the use of Gel@ExmodAtf5 was shown to be a highly effective strategy for OA treatment. The in vivo therapeutic effect of Gel@ExmodAtf5 was evidenced by the preservation of the intact cartilage surface, low OARSI scores, fewer osteophytes, and mild subchondral bone sclerosis and cystic degeneration. Consequently, the combination of ExmodAtf5 and PLGA-PEG-PLGA could significantly enhance the therapeutic efficacy and prolong the exosome release. In addition, the mitochondrial protease ClpP enhanced chondrocyte autophagy by modulating the mTOR/Ulk1 pathway. As a result of our research, Gel@ExmodAtf5 can be considered to be effective at alleviating the progression of OA.

To propose a modified approach to measuring femoro-epiphyseal acetabular roof (FEAR) index while still abiding by its definition and biomechanical basis, and to compare the reliabilities of the two methods. To propose a classification for medial sourcil edges. We retrospectively reviewed a consecutive series of patients treated with periacetabular osteotomy and/or hip arthroscopy. A modified FEAR index was defined. Lateral center-edge angle, Sharp's angle, Tonnis angle on all hips, as well as FEAR index with original and modified approaches were measured. Intra- and inter-observer reliability were calculated as intraclass correlation coefficients (ICC) for FEAR index with both approaches and other alignments. A classification was proposed to categorize medial sourcil edges. ICC for the two approaches across different sourcil groups were also calculated. After reviewing 411 patients, 49 were finally included. Thirty-two patients (40 hips) were identified as having borderline dysplasia defined by an LCEA of 18 to 25 degrees. Intra-observer ICC for the modified method were good to excellent for borderline hips; poor to excellent for DDH; moderate to excellent for normal hips. As for inter-observer reliability, modified approach outperformed original approach with moderate to good inter-observer reliability (DDH group, ICC=0.636; borderline dysplasia group, ICC=0.813; normal hip group, ICC=0.704). The medial sourcils were classified to 3 groups upon its morphology. Type II(39.0%) and III(43.9%) sourcils were the dominant patterns. The sourcil classification had substantial intra-observer agreement (observer 4, kappa=0.68; observer 1, kappa=0.799) and moderate inter-observer agreement (kappa=0.465). Modified approach to FEAR index possessed greater inter-observer reliability in all medial sourcil patterns. The modified FEAR index has better intra- and inter-observer reliability compared with the original approach. Type II and III sourcils accounts for the majority to which only the modified approach is applicable.

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.

Objective We sought to correlate various spinopelvic and lower limb alignments, and to examine the current spinopelvic theories on a Chinese cohort. Methods We retrospectively reviewed 166 patients undergoing THA. Among them, 138 patients with unilateral THA met the inclusion criteria. Sagittal alignments and cup orientations were measured on standing and sitting lateral EOS images. Patients were categorized into two groups with a scoring system for lumbar spine degeneration. Patients’ demographics including age, sex, lumbar spine degeneration and radiographic measurements were studied. Results PT, SS, LL and TK differed significantly between standing and sitting within each group except for TK in degenerative group (32.8 ± 13.9 vs. 32.9 ± 14.2, p = 0.905). Compared with degenerative spine group, non-degenerative spine patients have great pelvic mobility (ΔPT, -24.4 ± 12.5° vs. -17.6 ± 10.7, p = 0.0008), greater lumbar mobility (ΔLL, -34.8 ± 15.2 vs. -21.7 ± 12.2, p = < 0.0001) and compensatory cup orientation changes (ΔRA, -15.5 ± 11.1 vs. -12.0 ± 8.4, p = 0.00920; ΔRI, -10.8 ± 11.5 vs. -5.6 ± 7.5, p = 0.0055). Standing PT and ankle dorsiflexion angle correlated positively (R 2 = 0.236, p = 0.005). Conclusion THA patients in this cohort showed a spinopelvic motion paradigm similar to that from previous studies on Caucasians. Ankle dorsiflexion indicate greater posterior pelvic tilt on standing. Surgeons should beware of risks of instability in patients with lower limb compensations. Advances in knowledge This study provides new insights into the clinical relevance of lower limb alignments to spinopelvic motion after THA in a relatively young Chinese population.

Abstract Background This study is aimed to investigate retrospectively the radiographic and clinical outcomes in children and young adults with cerebral palsy (CP) undergoing periacetabular osteotomy (PAO) with or without femoral osteotomy (FO) for hip subluxation. Methods A consecutive cohort of twenty-one patients (23 hips) with symptomatic CP hip subluxation were treated with PAO with or without FO and reviewed retrospectively. Two patients (2 hips) were excluded due to insufficient follow-up and lost to follow-up, respectively. The Reimers migration percentage, lateral center-edge angle (LCEA), Sharp angle, neck-shaft angle (NSA), femoral anteversion (FNA), Gross Motor Function Classification System (GMFCS) and hip pain were assessed. Results Twenty-one hips (19 patients) with CP treated with PAO with or without FO were included. Five hips received PAO. Sixteen hips underwent PAO with FO. Mean age at surgery was 19 ± 6 and 15 ± 4 years for PAO and PAO plus FO, respectively. Mean follow-up was 44.0 ± 28.3 months for PAO and 41.5 ± 17.2 months for PAO + FO. All hips were painful before surgery and painless at final visits. The GMFCS improved by one level in 10 of 19 patients. There was significant increase in LCEA (p < 0.001) and decrease in the Reimer’s MP (p < 0.001), NSA (p < 0.001) and Tonnis angle(p < 0.001) postoperatively. Resubluxation occurred in 7 hips (30%) due to insufficient correction and loosening of fixation. Nervus cutaneus femoris lateralis was impaired in 4 patients after surgery. There was no avascular necrosis of the femoral head, resubluxation or infection. Conclusion PAO with or without FO can be effective for children and young adults with concomitant hip subluxation and CP.

Three-dimensional (3D) bioprinting technology, allowing rapid prototyping and personalized customization, has received much attention in recent years, while regenerated silk fibroin (RSF) has also been widely investigated for its excellent biocompatibility, processibility, and comprehensive mechanical properties. However, due to the difficulty in curing RSF aqueous solution and the tendency of conformational transition of RSF chains under shearing, it is rather complicated to fabricate RSF-based materials with high mechanical strength through extrusion bioprinting. To solve this problem, a printable hydrogel with thixotropy was prepared from regenerated silk fibroin with high-molecular-weight (HMWRSF) combined with a small amount of hydroxypropyl methylcellulose (HPMC) in urea containing aqueous solution. It was found that the introduction of urea could not only vary the solid content of the hydrogel to benefit the mechanical properties of the 3D-bioprinted pre-cured hydrogels or 3D-bioprinted sponges, but also expand the "printable window" of this system. Indeed, the printability and rheological properties could be modulated by varying the solid content, the heating time, the urea/HMWRSF weight ratio, etc. Moreover, the microstructure of nanospheres stacked in these lyophilized 3D-bioprinted sponges was interesting to observe, which indicated the existence of microhydrogels and both "the reversible network" and "the irreversible network" in this HMWRSF-based pre-cured hydrogel. Like other HMWRSF materials fabricated in other ways, these 3D-bioprinted HMWRSF-based sponges exhibited good cytocompatibility for dental pulp mesenchymal stem cells. This work may inspire the design of functional HMWRSF-based materials by regulating the relationship between structure and properties.

Abstract Background Osteoarthritis (OA) is a common chronic arthritis disease characterized by cartilage degeneration, sub-cartilage bone hyperplasia, osteophyte formation and joint space stenosis. Traditionally, OA treatment consists of pain management with joint replacement for end-stage disease. Patients diagnosed with OA have developed irreversible organic changes, so the focus should be shifted to prevention, early diagnosis and intervention of OA.Methods The differentially expressed genes (DEGs) were identified from the gene expression profile GSE48556 from the GEO database, and functional enrichment analyses were performed. Boruta algorithm and the least absolute shrinkage and selection operator (LASSO) analysis were used to select hub genes, then we used the LightGBM to evaluate the accuracy of hub genes prediction for OA. The CIBERSORT algorithm was used to analyze the immune infiltration of peripheral blood mononuclear cells (PBMCs) between OA and normal controls.Results A total of 35 DEGs including 29 downregulated genes and 6 upregulated genes were mainly involved in response to tumor necrosis factor (TNF) and TNF-mediated signaling pathway through GO analysis and were mainly enriched in cAMP signaling pathway, NF-κB signaling pathway through KEGG. The LightGBM prediction of the hub gene model showed that area under curve (AUC) of ROC curve and PR curve reached 0.988 and 0.996 respectively in verification set, indicating that hub genes have a high diagnostic accuracy for OA. Gene ADRB2 was the only up-regulated gene in OA group. H3F3B showed the largest AUC which means a high diagnostic power of OA. From the immune infiltration analysis, the content of CD8+ T cells and resting mast cells showed significant differences between the two groups and hub genes were closely related to immune cells.Conclusion The hub genes in PBMCs between OA and normal controls may potentially serve as biomarkers in both prevention and diagnosis of OA and indicate for the exploration of the mechanism of OA.

OBJECTIVE:This study was aimed to utilize a modified anterior drawer test (MADT) to detect the anterior cruciate ligament (ACL) ruptures and investigate its accuracy compares with three traditional tests.METHODS:Four hundred patients were prospectively enrolled between January 2015 and September 2017 preoperatively to undergo knee arthroscopic surgeries. The MADT, anterior drawer test, Lachman test, and pivot shift test were used in the outpatient clinical setting and were compared statistically for their accuracy in terms of ACL ruptures, with arthroscopic findings as the gold standard.RESULTS:The prevalence of ACL ruptures in this study was 37.0%. The MADT demonstrated the highest sensitivity (0.89) and accuracy (0.92) among the four tests and had comparable specificity (0.94) and a positive predictive value (0.90) compared with the anterior drawer test, Lachman test, and pivot shift test. The diagnostic odds ratio (DOR) of MADT was 122.92, with other test values of no more than 55.45. The area under the receiver operating characteristic curve (AUC) for the MADT was 0.92 ± 0.01, with a significant difference compared with that for the anterior drawer test (z = 17.00, p < 0.001), Lachman test (z = 9.66, p = 0.002), and pivot shift test (z = 16.39, p < 0.001). The interobserver reproducibility of the MADT was good, with a kappa coefficient of 0.86. When diagnosing partial tears of ACL, the MADT was significantly more sensitive than the anterior drawer test (p < 0.001), Lachman test (p = 0.026), and pivot shift test (p = 0.013). The MADT showed similar sensitivity in detecting anteromedial and posterolateral bundle tears (p = 0.113) and no difference in diagnosing acute and chronic ACL ruptures (χ2 = 1.682, p = 0.195).CONCLUSIONS:The MADT is also an alternative diagnostic test to detect ACL tear, which is equally superior to the anterior drawer test, Lachman test, and pivot shifting test. It could improve the diagnosis of ACL ruptures combined with other clinical information including injury history, clinical examination, and radiological findings.LEVELS OF EVIDENCE:Level II/observational diagnostic studies TRIAL REGISTRATION: Chinese Clinical Trial Registry. ChiCTR1900022945 /retrospectively registered.

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.

Background Postoperative delirium (PD), as an acute brain failure, is widely reported as a very common postoperative complication, and it is closely associated with increased morbidity and mortality. Recently, malnutrition is reported as one of the risk factors for PD. The prognostic nutritional index (PNI) is a simple method for nutritional evaluation. However, few studies have discussed the effectiveness of PNI as a nutritional assessment in predicting PD after primary total joint arthroplasty (TJA). The aim of this study is to investigate potential risk factors including PNI for PD following primary TJA. Methods A retrospective analysis of 994 patients was performed to identify risk factors associated with PD after primary TJA by using univariate and multivariate analyses. A receiver operating characteristic curve and the area under the curve were applied to evaluate the significant results of the multivariate analysis and the optimal cutoff value (CV). Results Postoperatively, sixty-seven patients (67/994, 6.7 %) experienced PD. Univariate analysis demonstrated that operative time, duration of anesthesia, age, hypertension, serum albumin, and PNI differed between the PD and non-PD groups ( P < 0.05). Multivariate logistic regression analysis showed that the preoperative PNI (odds ratio [OR]: 0.908; 95 % confidence interval [CI]: 0.840–0.983; CV: 47.05), age of patients (OR: 1.055; 95 % CI: 1.024–1.087; CV: 73.5 years), and hypertension (OR: 1.798; 95 % CI: 1.047–3.086), were independently associated with PD ( P < 0.05). Conclusions A low preoperative PNI associated with malnutrition was demonstrated to be an independent risk factor for PD following primary TJA. Patients with preoperative low PNI should be cautioned and provided with adequate nutritional intervention to reduce postoperative PD.

Core decompression of the femoral head is a recommended head-conserving strategy for early-stage osteonecrosis of the femoral head. However, no ideal filling material has been found so far. In this study, we fabricated a "solid core-porous coating" composite scaffold, which is a silk fibroin/hydroxypropyl methylcellulose (SF/HPMC) scaffold, by a "two-step" process. The solid core scaffold possesses a sufficient compression modulus (860 MPa) for support, while the porous coating scaffold with controllable pore size and porosity provides a suitable microenvironment for the osteoblast cell to adhere and proliferate. Moreover, the porous coating scaffold was mineralized by adding different contents of hydroxyapatite crystal to further enhance its osteoinductivity, according to the simulated body fluid (SBF) biomineralization assay. To demonstrate the biocompatibility and osteoinductivity of such composite scaffolds, a series of in vitro experiments were performed, indicating the MC3T3-E1 pre-osteoblast cells grew and differentiated well on the mineralized porous coating scaffolds. The mechanical testing results also proved that the mechanical property of the solid core scaffold varied (230-1600 MPa) with different solid contents of SF/HPMC, as expected. Furthermore, the rabbit femoral head core decompression model was adopted and confirmed the excellent mechanical performance of the solid core scaffolds, as well as the satisfied osteoinductivity of the porous coating scaffold, by inserting the composite scaffolds into the bone tunnel in vivo. All of the preliminary results implied that the novel biodegradable composite scaffold has an outstanding prospective for the clinical use of core decompression of the femoral head.

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.

Background:Malnutrition is reported as one of the risk factors for surgical site infection (SSI). The prognostic nutritional index (PNI) is a simple method for nutritional evaluation. However, few studies have discussed the effectiveness of PNI as a nutritional assessment in predicting SSI after primary total knee arthroplasty (TKA). The aim of this study is to investigate the relationship between SSI and malnutrition as identified by the PNI scores following TKA. Methods: A retrospective analysis of 483 patients (SSI vs. non-SSI group: 19 vs. 464; follow-up period: at least 1 year) was performed to confirm the risk factors, including the PNI, associated with SSI after primary TKA using both univariate and multivariate analyses. Results: Postoperatively, nineteen patients (19/483, 3.9%) experienced SSI (deep vs. superficial SSI: 12 vs. 7), and periprosthetic joint infection was observed in all deep SSI cases. Univariate analysis showed that male sex, body weight, body mass index (BMI), diabetes mellitus, steroid usage, operative time and PNI differed between the SSI and non-SSI groups (P<0.05). Multivariate logistic regression analysis identified that the preoperative PNI (odds ratio [OR]: 0.859; 95% confidence interval [CI]: 0.762-0.969; cutoff [CV]: 49.27), operative time (OR: 1.005; 95% CI: 1.000-1.010; CV: 131.0 min), male sex (OR: 4.127; 95% CI: 1.165-14.615), diabetes mellitus (OR: 6.133; 95% CI: 2.067-18.193) and steroid usage (OR: 6.034; 95% CI: 1.521-23.935) were independently associated with SSI (P<0.05). Conclusions: A low preoperative PNI associated with malnutrition was demonstrated to be an independent risk factor for SSI following primary TKA. Patients with preoperative low PNI should be cautioned and provided with adequate nutritional intervention to reduce postoperative SSI.

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.