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The present study shows the case of a patient with acetabular protrusions secondary to rheumatoid arthritis progressing to femoral neck fracture.The patient,a 64 years female,had a history of rheumatoid arthtitis for 38 years.The left hip pain and abnormal sound occurred when hip flexion for picking up.She was diagnosed with rheumatoid arthritis secordary to acetabular pelvic retraction and left femoral neck fracture by medical history,physical examination and imaging.Total hip arthroplasty was performed after preoperative examination.Hip dislocation,femoral head removal,acetabular reconstruction;cup fixation,and bone mass assessment are technical challenges during surgery.Based on literature review,this case is belonging to secondary acetabular pelvic retraction,which may be related to acetabular softening caused by rheumatoid arthritis.Whenthe stress from the femoral head exceeds the endurance of the softened acetabulum,the acetabulum protrudes into the pelvis and gradually wraps around the femoral head.Based on the pathological characteristics,itis speculated that the cause of femoral neck fracture is the direct hit of the femoral neck-acetabular rim during hip flexion.In this case,spiral cup prosthesis was used to achieve both the initial stability of the prosthesis and saving bone mass around the acetabulum.The patient was followed up for 3 months with satisfactory position of prosthesis and joint function.
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Objective To observe the clinical outcomes of the surgical management of periprosthetic femoral fractures following hip arthroplasty.Methods Twelve consecutive patients (6 male and 6 female) with the average age of 66.4± 15.0 years old (35 to 86 years old) undergoing surgical operation for periprosthetic femoral fractures between September 2009 and May 2016 were followed up at our center.Nine cases were fractured secondary to the primary hip arthroplasty while the others were patients with earlier revision surgery.The previous fixations of femoral components of 10 cases were cementless while the other two were cemented fixation.The enrolled patients were determined as Vancouver type B 1 (n=2),type B2 (n=7),type B3 (n=1) and type C (n=2) respectively.The occurrences of the fractures were observed at 3 weeks to 17 years post-operation (average 9.0±7.0 years).The patients were treated individually according to different Vancouver types.Type B 1 patients received simple cerclage fixation,as well as revisions with long-stem femoral implants and cerclage band were chosen for type B2 patients.In addition to the treatment for type B2 patients,allogenic cortical bone graft was also required for type B3 patients.Open reduction with locking plate internal fixations were options for patients with Vancouver type C fractures.The following-up included the X-ray images of the hips,Harris hip score and the visual analogue scale (VAS) for the pain of fracture site.The unions of the fractures were determined by both X-ray images and pain intensity of the fracture sites.Results The mean follow-up period was 41.6±26.0 months (range,12-92 months),without patient lost to follow up.VAS scores were 0,implying the clinical union of the fractures.One patients received multiple debridement post-operatively due to the periprosthetic infection.The VAS score of this patient was 6 at the follow up and the X-ray image indicated the nonunion of the fracture.The fracture union rate was 91.7％ (11/12).The Harris hip score was 23-92 (mean score,74.8±18.8),excellent for 2 cases,good for 6 cases,fair for 3 cases and poor for 1 case.The excellent and good rate was 66.7％ (8/12).Post-operative complications were observed in 4 patients (33.3％,4/12).One drainage tube was misplaced and sutured subcutaneously required a further exploration surgery.One periprosthetic infection occurring post-operatively induced the nonunion of the fracture.Aseptic loosing of femoral stem was observed in 2 cases and subsequent revision surgeries were conducted.Conclusion High incidence of complications is observed after the surgical treatment of periprosthetic femoral fractures following hip arthroplasty.Individually customized management regarding to the Vancouver type of periprosthetic femoral fractures leads to the clinical fracture union in 91.7％ of the patients in this case series.The excellent and good rate of the hip function in the early and mid-term stage after operation is 66.7％.
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With the increasing number of hip arthroplasty and the extension of implant survival,the risk of periprosthetic femoral fractures are gradually growing.The technical challenge of the surgical management of periprosthetic femoral fractures leads to poor functional outcome,implant survival and patient satisfaction compared to primary hip arthroplasty.The risk factors of periprosthetic femoral fractures involve both of the bone quality of the patient and the surgical techniques of the primary surgery,including age and gender of the patient,osteoporosis,previous surgical history and the type of the components.In order to avoid the occurrence of periprosthetic fractures,precautions including the assessment of the patient status and bone quality as well as the selection of proper prosthesis and surgical procedures should be taken before the primary surgery.During the primary surgery,more attention should be paid to prevent the damage of host bone and make sure the correct placement of the implants.The aseptic loosening should be detected and treated as early as possible in the regular post-operative follow up.The diagnosis of periprosthetic femoral fracture mainly bases on the detailed history,symptoms,signs and serial X-rays after operation.The most extensively used classification system of the periprosthetic femoral fracture is the Vancouver classification.For the treatment of different types of fractures,conservative therapy is recommended for most Vancouver type A fractures.The surgical management is the best choice for most Vancouver type B fractures.Whether the stem revision is necessary or not depends on the stability the component.The treatment of Vancouver type C fractures should be in accordance with the principles of regular femur fractures.However,more attention should be paid to choose proper device according to the existence of the femoral component in the proximal part of the fracture.Through the analysis of the pathogenesis and risk factors of periprosthetic femoral fractures and the discussion of the diagnosis,classification and treatment principles,we expect to provide a standard treatment protocol for the periprosthetic femoral fractures following hip arthroplasty.
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Objective To investigate the effects of chemokine like factor 1 (CKLF1) gene on the proliferative activities and osteogenic potentials of hip ligaments of ankylosing spondylitis (AS) in situ and in vitro. Methods Normal and AS hip ligament specimens were collected from 6 patients with femoral neck fracture and 4 AS patients with severe hip deformities. Ligament specimens were exposed to type Ⅱ colla-genase and obtained a single cell suspension, while phase contrast microscopy and anti-vimentin immuno- fluorescence staining (IFC) were applied to observe the cells. The specimens and fibroblasts were divided and cultured in situ and in vitro respectively, and the recombinant adeno-associated virus (rAAV)-lacZ (E. coli beta-galactosidase gene)and rAAV-hCKLF1 (human CKLF1 cDNA cloned in rAAV-lacZ in place of lacZ) were transduced for 21 days. Cell proliferation (cellularity), secretion of pro-inflammatory cytokines, expression of CKLF1 and CCR4 genes were detected by the water-soluble tetrazolium (WST-1) assay and Hoechst 33258 test (DNA content), enzyme-linked immunosorbent assay (ELISA), IFC test and fluorescent quantitative reverse transcription polymerase chain reaction (RT-PCR), respectively. Statistical analysis significance was conducted using the Student's t test and one-way analysis of variance (ANOVA) (LSD) test where appropriate. Results The second passage of normal and AS cells were positive for anti-vimentin, indicating that the cells were fibroblasts. After transducing with rAAV-hCKLF1 for 21 days, cellularity, WST-1 and Hoechst 33258 assays illustrated that CKLF1 gene transfer promoted cell proliferation (compared with the non-viral transduction and lacZ groups, F=6.98, 64.32, 115.91, P<0.05 or P<0.01). Overexpression of CKLF1 gene enhanced the secretion of pro-inflammatory cytokines (interleukin-6 and tumor necrosis factor-alpha) and the expression of bone-specific extracellular matrix proteins (osteopontin and osteocalcin) (F=34.57, 8.89, P<0.05 or P<0.01). Similar results were observed in fluorescent quantitative RT-PCR test. Conclusion Overexpression of CKLF1 promotes the proliferation of fibroblasts, the secretion of pro-inflammatory cytokines and the expression of osteogenic related target genes, suggesting that CKLF1 might be involved in the pathological ossification of AS.
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Objective To investigate the effects of chemokine like factor 1 (CKLF1) gene on the proliferative activities and osteogenic potentials of hip ligaments of ankylosing spondylitis (AS) in situ and in vitro. Methods Normal and AS hip ligament specimens were collected from 6 patients with femoral neck fracture and 4 AS patients with severe hip deformities. Ligament specimens were exposed to type Ⅱ colla-genase and obtained a single cell suspension, while phase contrast microscopy and anti-vimentin immuno- fluorescence staining (IFC) were applied to observe the cells. The specimens and fibroblasts were divided and cultured in situ and in vitro respectively, and the recombinant adeno-associated virus (rAAV)-lacZ (E. coli beta-galactosidase gene)and rAAV-hCKLF1 (human CKLF1 cDNA cloned in rAAV-lacZ in place of lacZ) were transduced for 21 days. Cell proliferation (cellularity), secretion of pro-inflammatory cytokines, expression of CKLF1 and CCR4 genes were detected by the water-soluble tetrazolium (WST-1) assay and Hoechst 33258 test (DNA content), enzyme-linked immunosorbent assay (ELISA), IFC test and fluorescent quantitative reverse transcription polymerase chain reaction (RT-PCR), respectively. Statistical analysis significance was conducted using the Student's t test and one-way analysis of variance (ANOVA) (LSD) test where appropriate. Results The second passage of normal and AS cells were positive for anti-vimentin, indicating that the cells were fibroblasts. After transducing with rAAV-hCKLF1 for 21 days, cellularity, WST-1 and Hoechst 33258 assays illustrated that CKLF1 gene transfer promoted cell proliferation (compared with the non-viral transduction and lacZ groups, F=6.98, 64.32, 115.91, P<0.05 or P<0.01). Overexpression of CKLF1 gene enhanced the secretion of pro-inflammatory cytokines (interleukin-6 and tumor necrosis factor-alpha) and the expression of bone-specific extracellular matrix proteins (osteopontin and osteocalcin) (F=34.57, 8.89, P<0.05 or P<0.01). Similar results were observed in fluorescent quantitative RT-PCR test. Conclusion Overexpression of CKLF1 promotes the proliferation of fibroblasts, the secretion of pro-inflammatory cytokines and the expression of osteogenic related target genes, suggesting that CKLF1 might be involved in the pathological ossification of AS.
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Emerging evidence has indicated that BRCC 36-mediated K63-linked ubiquitination modification was involved in diverse cellular functions , including endocytosis , apoptosis and DNA damage repair .We previously showed that activation of cGMP/PKG pathway con-tributed to the binding of BRCC36 and the pro-fibrotic factor Smad3.The current study tested the hypothesis that BRCC 36 functions as a negative regulator of transforming growth factor-beta ( TGF-β)/Smad3 pathway and participates in cardiac remodeling .In isolated adult mouse cardiac fibroblasts , we have demonstrated that TGF-β1 treatment significantly increased the expression of BRCC 36.Over-expression BRCC36 suppressed TGF-β1-induced Smad3 phosphorylation, nuclear translocation, extracellular matrix molecular expres-sion and cell proliferation .On the contrary, silencing BRCC36 by transfection of adenovirus-carrying BRCC36 shRNA potentiated to enhance the pro-fibrotic effect of TGF-β.In vivo, under chronic pressure overload condition-induced by transverse aortic constriction , myocardial pro-survival protein Bcl-2 and Mcl-1 expression were significantly decreased and the pro-apoptosis protein Puma was in-creased.However, the cardiac-specific over-expression of BRCC36 significantly increased myocardial Bcl-2 and Mcl-1 and inhibited Puma expression .Interestingly , we also found that sustained pressure overload resulted in a significant myocardial DNA injury in wild type mice, which was characterized by the increase of γH2AX level.However, cardiac-specific BRCC36 over-expression significantly decreased the level of γH2AX in the pressure overloaded heart in the transgenic mice , while effectively enhanced myocardial RAD 51 expression, a marker of DNA damage repair.Furthermore, BRCC36 over-expression effectively attenuated TAC-induced cardiac fibro-sis and remodeling in the transgenic mice , compared with the wild type mice .Collectively , the results have suggested that BRCC 36 ef-fectively protected heart against chronic pressure overload-induced cardiac remodeling though antagonizing TGF-β/Smad3 pathway and enhancing myocardial DNA injury repair response .
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<p><b>OBJECTIVE</b>To compare and estimate the diagnostic value and characteristic of different diagnostic methods (blood laboratory test, histological analysis, synovial fluid cytological test and microbiological examination) in detecting the presence of periprosthetic joint infection.</p><p><b>METHODS</b>Data of 52 patients underwent hip or knee joint revision in Peking University People's Hospital Arthritis Clinic and Research Center between July 2013 and March 2015 were analyzed retrospectively. For each patient, results of blood laboratory tests(peripheral-blood white blood cell, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), interleukin-6 (IL-6) and high-sensitivity C-reactive protein (Hs-CRP)), histological analysis, synovial fluid white cell count (SWCC), microbiological examinations (synovial fluid, tissue and prosthetic joint sonication fluid) were collected. Data were analyzed by t-test, independent sample median test or χ(2) test, respectively. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy for each method were calculated and compared by receiver operating characteristic curve.</p><p><b>RESULTS</b>There were 30 female and 22 male patients. Twenty-one patients (40.4%) were diagnosed as PJI. The levels of CRP, ESR, IL-6 and Hs-CRP in patients with PJI were higher than that in aseptic failure patients (Z=23.084, 13.499, 5.796, 17.045, all P<0.05). The sensitivities of CRP, ESR, IL-6 and Hs-CRP were 90.5%, 81.0%, 95.0% and 90.0%. The sensitivities of histological analysis and SWCC were 55.0% and 70.6%, while they had high specificity as 89.7% and 85.7%. The sensitivity of sonication fluid culture was 90.0%, which was higher than that of tissue culture (71.4%) and synovial fluid culture (65.0%) (χ(2) = 5.333, 6.400, all P<0.05).</p><p><b>CONCLUSIONS</b>The tests of CRP, ESR, IL-6 and Hs-CRP have good value in detecting PJI preoperatively. Histological analysis and SWCC have high specificity, which could help to exclude PJI. Sonication fluid culture has a higher sensitivity than tissue culture and synovial fluid culture.</p>
Subject(s)
Female , Humans , Male , Arthroplasty, Replacement, Hip , Arthroplasty, Replacement, Knee , Blood Sedimentation , C-Reactive Protein , Metabolism , Interleukin-6 , Blood , Knee Joint , Prosthesis-Related Infections , Diagnosis , ROC Curve , Retrospective Studies , Sensitivity and Specificity , Synovial Fluid , Cell BiologyABSTRACT
Objective To explore the classification of degenerative medial meniscus injury under arthroscopy and its clinical significance.Methods This study involved 122 patients who underwent arthroscopic operation because of degenerative medial meniscus injury from January 2012 to December 2012,eliminating patients who received synovectomy for severe synovitis.There were 27 males and 95 females,with 63 left knees and 59 right knees.The average age was 61.8±8.9 years.The average BMI was 26.5±3.4 kg/m2,while the average preoperative Lysholm score was 47.2± 15.0.The cartilage injury was estimated by Outerbridge classification system during arthroscopic surgery.Both the difference of the preoperative Lysholm score and the number of articular surfaces with Ⅳ degree of cartilage injury were compared among different types of degenerative medial meniscus injury.Resuits The horizon tear of posterior horn group included 33 patients.The average number of articular surfaces with Ⅳ degree of cartilage injury was 1.24± 1.48 while the average preoperative Lysholm score was 52.5± 14.4 points,with pain score of 7.7±6.5.The root injury of posterior horn group included 16 patients,whose average number of articular surfaces with 1Ⅳ degree of cartilage injury was 1.13±1.26 and average preoperative Lysholm score was 37.5±8.4 points,with pain score of 3.1±4.0.The complex serious injury group included 73 patients.The average number of articular surfaces with Ⅳ degree of cartilage injury was 2.26±1.61 and the average preoperative Lysholm score was 46.9±15.3 points,with pain score of 6.8±5.4.Both the preoperative Lysholm score and pain score of the root injury of posterior horn group was significantly lower than that of the horizon tear and the complex serious injury group.The average number of articular surfaces with Ⅳ degree of cartilage injury between the root injury and the horizon tear of posterior horn group had no significant difference.The number of these two groups was less than the complex serious injury group,with statistically significant difference.Conclusion The arthroscopic classification of degenerative medial meniscus injury could be classified into three types.The degenerative cartilage injury of root injury of posterior horn and horizon tear of posterior horn is relatively mild,which are the early stages of joint degeneration.However,the clinical symptoms and disability caused by root injury of posterior horn are more severe.On the other hand,the degenerative cartilage injury of complex serious injury is relatively severe,which belongs to the late stage,while the clinical symptoms and disability are relatively mild.
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The protein of BRCC36 is a kind of enzyme specifically hydrolyzing K 63-linked poly-ubiquitin chain and widely found in a variety of eukaryotic cells .BRCC36 recognizes diverse substrate proteins , and participates in various kinds of pathophysiological responses such as DNA damage repair , cell signal transduction and cell cycle control .It plays an important role in the process of cancer , angiogenesis and cardiac injury .This review discusses the progress in the inves-tigation on BRCC36 protein to provide the necessary information for searching new therapeutic targets of many diseases .