Advances in biotransformation of methanol into chemicals / 生物工程学报

Methanol has become an attractive substrate for the biomanufacturing industry due to its abundant supply and low cost. The biotransformation of methanol to value-added chemicals using microbial cell factories has the advantages of green process, mild conditions and diversified products. These advantages may expand the product chain based on methanol and alleviate the current problem of biomanufacturing, which is competing with people for food. Elucidating the pathways involving methanol oxidation, formaldehyde assimilation and dissimilation in different natural methylotrophs is essential for subsequent genetic engineering modification, and is more conducive to the construction of novel non-natural methylotrophs. This review discusses the current status of research on methanol metabolic pathways in methylotrophs, and presents recent advances and challenges in natural and synthetic methylotrophs and their applications in methanol bioconversion.

An evidence-based clinical guideline for the treatment of infectious bone defect with induced membrane technique (version 2023) / 中华创伤杂志

Infectious bone defect is bone defect with infection or as a result of treatment of bone infection. It requires surgical intervention, and the treatment processes are complex and long, which include bone infection control,bone defect repair and even complex soft tissue reconstructions in some cases. Failure to achieve the goals in any step may lead to the failure of the overall treatment. Therefore, infectious bone defect has been a worldwide challenge in the field of orthopedics. Conventionally, sequestrectomy, bone grafting, bone transport, and systemic/local antibiotic treatment are standard therapies. Radical debridement remains one of the cornerstones for the management of bone infection. However, the scale of debridement and the timing and method of bone defect reconstruction remain controversial. With the clinical application of induced membrane technique, effective infection control and rapid bone reconstruction have been achieved in the management of infectious bone defect. The induced membrane technique has attracted more interests and attention, but the lack of understanding the basic principles of infection control and technical details may hamper the clinical outcomes of induced membrane technique and complications can possibly occur. Therefore, the Chinese Orthopedic Association organized domestic orthopedic experts to formulate An evidence-based clinical guideline for the treatment of infectious bone defect with induced membrane technique ( version 2023) according to the evidence-based method and put forward recommendations on infectious bone defect from the aspects of precise diagnosis, preoperative evaluation, operation procedure, postoperative management and rehabilitation, so as to provide useful references for the treatment of infectious bone defect with induced membrane technique.

Iodine nutritional status of children and pregnant women in 37 coastal counties (cities and districts) of Shandong Province in 2021 / 中华地方病学杂志

Objective:To learn about the prevalence of iodized salt in coastal counties (cities and districts, hereinafter referred to as counties) of Shandong Province, evaluate the iodine nutritional status of children and pregnant women, so as to provide data support for timely targeted prevention and control measures and scientific adjustment of intervention strategies.Methods:In 2021, in 37 coastal counties of Shandong Province, one township was selected from each of the five directions of the east, west, south, north, and middle of each county, one primary school was selected from each township, 40 non-boarding students aged 6 - 12 years old were selected from each primary school. In addition, 20 pregnant women were selected from each township. Children's and pregnant women's household salt samples and urine samples were collected to detect salt iodine and urinary iodine contents. The children from 19 counties selected from the 37 coastal counties of Shandong Province were examined by B-mode ultrasound, and the goiter rate of children was calculated.Results:Totally 7 736 household edible salt samples from the children were tested, and the coverage rate of iodized salt, iodized salt qualified rate and qualified iodized salt consumption rate was 74.3% (5 746/7 736), 74.3% (4 267/5 746) and 55.2% (4 267/7 736), respectively. A total of 7 740 urine samples were collected from the children, the median urinary iodine was 174.0 μg/L. A total of 4 344 children were selected for thyroid examination, and the goiter rate was 3.0% (131/4 344). Totally 4 513 household edible salt samples from the pregnant women were tested, and the coverage rate of iodized salt, iodized salt qualified rate and qualified iodized salt consumption rate was 83.7% (3 779/4 513), 77.6% (2 933/3 779) and 65.0% (2 933/4 513), respectively. A total of 7 740 urine samples were collected from the pregnant women, the median urinary iodine was 133.5 μg/L.Conclusions:Children in 37 coastal counties of Shandong Province are generally at the appropriate level of iodine, but pregnant women still have the risk of iodine deficiency. Comprehensive prevention and control measures for iodine deficiency disorders need to be continuously implemented to consolidate and deepen the achievements of iodine deficiency prevention and control.

Discussion on promoting the prevention and control of endemic diseases in the new era / 中华地方病学杂志

The prevention and control of endemic diseases belongs to public health undertakings, and public health issues are of great importance to the national economy and people's livelihood. This paper discusses how to promote the further development of the prevention and control of endemic diseases based on the actual situation of the prevention and control of endemic diseases. It is suggested that measures should be taken to develop a long-term mechanism and improve the system construction, so as to realize the sustainable development of endemic disease prevention in the new era and better meet the health needs of the people.

Spatial distribution characteristics of Keshan disease in Shandong Province / 中华地方病学杂志

Objective:To investigate the spatial distribution characteristics of Keshan disease in Shandong Province, and to provide evidence for prevention and control of Keshan disease.Methods:The incidence data of Keshan disease in Shandong Province from 1960 to 2018 were collected from Shandong Provincial Institute for Endemic Disease Control and Prevention, and a spatial database was built. Global and local spatial autocorrelation (Moran's I) were analyzed by ArcGIS 10.2 and GeoDa 1.14 softwares, respectively. Local indicators on spatial association (LISA) aggregation graph was drawn. This allowed us to investigate the spatial autocorrelation and cluster range of the distribution of Keshan disease in Shandong Province. Results:A total of 4 172 cases of Keshan disease were reported in Shandong Province with an annual incidence rate of 0 to 51.4/10 000 of the population at the township-level from 1960 to 2018. Global spatial autocorrelation analysis on the incidence of Keshan disease at the township-level showed that global Moran's I values ranged from 0.020 to 0.429 in 1962 - 1964, 1969 - 1985, 1989, 1995, 1998 - 2001 and 2004 - 2016 ( P < 0.05), thus indicating significant spatial autocorrelation overall. LISA analysis further revealed that high-high clusters of Keshan disease existed in 1960, 1962 - 1964, 1969 - 1985, 1989, 1998 - 2000 and 2002 - 2016. These clusters were predominantly distributed in three areas: Zoucheng City, Pingyi County and Sishui County in the southwest of Shandong Province; Wulian County and Ju County in the southeast of Shandong Province; and Qingzhou City, Linqu County and Yishui County in the central and middle-south of Shandong Province. Conclusions:Keshan disease exhibits significant spatial autocorrelation in Shandong Province. High-high clusters are mainly located in certain townships in the southwest, southeast, central and middle-south of Shandong Province.

Association of single nucleotide polymorphism of TNF-α gene G308A with obesity and metabolic disorder in children / 中华内分泌代谢杂志

Objective:To investigate the association of tumor necrosis factor-α(TNF-α)gene G308A single nucleotide polymorphism(SNP)with childhood obesity and metabolic disorders.Methods:A total of 620 obese children admitted to our pediatric department from January 2015 to December 2019 were selected as research subjects, who were divided into metabolic non-healthy group( n=267)and metabolic healthy group( n=353), and 260 healthy children were selected as the control group. Single nucleotide polymorphism of TNF-α gene G308A was detected, serum TNF-α level, obesity indicators, glucose and lipid metabolism indicators were compared among the children in various groups. Results:No significant differences in body mass index(BMI), waist circumference, hip circumference, and serum TNF-α level were found between metabolic non-healthy group and metabolic healthy group( P>0.05), but higher than those in control group( P<0.05). There were no significant differences in fasting plasma glucose(FPG)and total cholesterol(TC) levels among the three groups( P>0.05). The levels of fasting insulin(FINS), fasting glucagon(FGC), HbA 1C, triglyceride(TG), and low density lipoprotein-cholesterol(LDL-C)in metabolic non-health group and metabolic health group were significantly higher than those in control group, higher in metabolic non-health group compared with metabolic healthy group( P<0.05). HDL-C level in two obese groups was significantly lower than that in control group, lower in metabolic non-health group compared with metabolic healthy group( P<0.05). The frequencies of GG genotype and allele G in metabolic non-healthy group and metabolic healthy group were significantly lower than those in control group, lower in metabolic non-health group compared with metabolic healthy group. The frequencies of AA, GA genotypes and allele A were significantly higher in metabolic non-health group than those in metabolic healthy group( P<0.05). There were no significant differences in TNF-α, FPG, and TC among AA, GA and GG groups( P>0.05). BMI, waist circumference, hip circumference, FINS, FGC, HbA 1C, TG, HDL-C and LDL-C were comparable between AA type and GA type( P>0.05), but revealed a significant difference compared with GG type( P<0.05). Pearson correlation analysis showed that the level of TNF-α was positively correlated with BMI, waist circumference, hip circumference, FPG, FINS, FGC, HbA 1C, TC, TG, and LDL-C( P<0.05), but negatively correlated with HDL-C( P<0.05). Conclusion:TNF-α gene G308A single nucleotide polymorphism is associated with obesity and metabolic disorders in children.

Application of MRI WARP sequence in periprosthetic joint infection / 中华创伤骨科杂志

Objective:To explore whether MRI WARP sequence can provide clearer musculoskeletal images to guide the operation for patients with periprosthetic joint infection (PJI) by comparing MRI WARP sequence images with conventional sequence images.Methods:The data were analyzed retrospectively of 23 PJI patients who had been diagnosed and treated at Department of Orthopedics, The First Affiliated Hospital to Fujian Medical University from January 2020 to February 2021. They were 13 females and 10 males, with an average age of 62.8 years (from 32 to 88 years). According to the MRI sequences, they were divided into a WARP group ( n=14) subjected to MRI scanning by WARP sequence and a conventional group ( n=9) subjected to MRI scanning by conventional sequence. The gender, age, erythrocyte sedimentation rate (ESR) and C-reaction protein (CRP) were recorded for both groups. The signal-to-noise ratios were compared between the 2 sequences and 2 experts evaluated the clarity and surgical guidance of the images. Results:There was no significant difference in gender, age, CRP or ESR between the 2 groups, showing comparability ( P>0.05). The 2 experts showed consistency in evaluation of image sharpness and surgical guidance ( P<0.05). The WARP group was significantly better than the conventional group in image sharpness score [2.25(2.0, 2.6) versus 1.00 (0.5, 1.0)], surgical guidance score [2.00(1.5, 2.5) versus 0.50(0, 0.8)], and signal-to-noise ratio [47.28 (32.8, 74.3) versus 21.67(13.5, 31.4)] ( P<0.05). Conclusion:MRI WARP sequence can provide clearer musculoskeletal images than conventional MRI sequence to better guide the operation for PJI patients.

Metagenomic Next Generation Sequencing applied in diagnosis of osteoarticular nontuberculous mycobacterial infection / 中华创伤骨科杂志

Objective:To investigate the value of metagenomic Next-Generation Sequencing (mNGS) in etiological diagnosis of osteoarticular nontuberculous mycobacterial (NTM) infection.Methods:From January 2014 to October 2019, 119 patients were definitely diagnosed as osteoarticular infection at Department of Bone Tumor & Joint Surgery, The First Affiliated Hospital to Fujian Medical University. All of them underwent conventional culture followed by mNGS to screen out those with NTM infection by the etiological testing. Optimized culture was conducted for NTM infections. Demographic data, and results of conventional culture, mNGS and optimized culture were recorded for patients with NTM infection.Results:mNGS showed that 12 of the 119 patients with osteoarticular infection (12/119, 10.1%) had NTM infection. They were 6 males and 6 females aged from 31 to 82 years(average, 51.1 years). There were 5 cases of slowly-growing mycobacterial type and 7 cases of rapidly-growing mycobacterial type. The positive rate of primary culture was only 16.7% (2/12) by the conventional culture, but increased to 66.7% (8/12) by the optimized culture. The positive rate of optimized culture was 100% (7/7) for the rapidly-growing mycobacterial type and 20% (1/5) for the slowly-growing mycobacterial type.Conclusion:As the positive rate of conventional culture is low for patients with osteoarticular NTM infection, mNGS is superior due to its advantage in accurate etiological diagnosis, especially for that of rapidly-growing mycobacterial type.

Two-stage total hip arthroplasty for chronic septic hip arthritis / 中华创伤骨科杂志

Objective:To analyze the clinical efficacy of two-stage total hip arthroplasty in the treatment of chronic septic hip arthritis.Methods:From January 2008 to March 2020, 17 patients with chronic septic hip arthritis (17 hips) received two-stage total hip arthroplasty at Department of Orthopaedic Surgery, The First Affiliated Hospital to of Fujian Medical University. They were 11 males and 6 females, with an average age of 54.5 years (from 19 to 77 years) and 9 left and 8 right hips affected. There were 10 cases of primary septic hip and 7 cases of secondary infection after hip surgery. Three patients had undergone debridement in other hospitals and one patient had developed a sinus tract. In the first stage operation, the diseased femoral head and neck were resected to implant an articulating spacer after thorough debridement; in the second stage operation, the spacer was removed to implant a uncemented artificial hip prosthesis in 16 cases or a cemented artificial hip prosthesis in one case. Recorded were the results of microbial culture, operation time, intraoperative blood loss, and therapeutic outcomes of the patients.Results:Pathogenic data were available in 13 patients and the culture was negative in 4. The pathogens were detected by metagenomic next-generation sequencing in 2 patients with culture negative. In the first stage operation, operation time averaged 140.6 min (from 90 to 176 min) and intraoperative blood loss 361.8 mL(from 100 to 1 000 mL); in the second stage operation, operation time averaged 130.3 min (from 91 to 166 min)and blood loss 291.2 mL(from 50 to 700 mL). The average interval between the first and the second stage operations was 115.0 days(from 66 to 227 d). During the interval, spacer fracture occurred in one case, spacer dislocation in one case and lower extremity deep venous thrombosis in one case. All the patients were followed up for 12 to 82 months (average, 36.7 months) after second stage operation. The inflammatory indexes decreased to normal in all the 17 patients and infection recurrence was observed in none of them.Conclusions:Two-stage total hip arthroplasty may result in a high rate of successful treatment of chronic septic hip arthritis. Specific use of sensitive antibiotics after identification of specific pathogenic microorganisms by multiple methods is the key to a successful treatment.

Clinical outcomes of articulating spacers in treatment of chronic knee periprosthetic joint infection / 中华创伤骨科杂志

Objective:To explore the clinical outcomes of articulating spacers in the treatment of chronic knee periprosthetic joint infection (PJI).Methods:A retrospective study was conducted of the 38 patients who had undergone stage-two revision for chronic knee PJI from January 2014 to January 2020 at Department of Articular Surgery, The First Affiliated Hospital to Fujian Medical University. They were 8 men and 30 women, aged from 37 to 84 years (average, 66.2 years). The PJI was unilateral in all, affecting 19 left sides and 19 right sides. According to the kind of spacers used in the stage-one revision, they were divided into 3 groups: metal-polyethylene one (10 cases), metal-cement one (15 cases) and cement one (13 cases). In the stage-two revision following infection control, the spacers were removed for sonication and microbial culture. Infection control, range of motion (ROM), Knee Society Score (KSS), and complications were followed up.Results:The 38 patients were followed up for an average of 30.8 months (from 13 to 75 months). All patients underwent spacer implantation at stage-one revision and infection was controlled in 37 of them (97.4%, 37/38). After stage-one revision, metal-polyethylene, metal-cement and cement groups achieved 95.0°±11.3°, 92.9°±8.3° and 75.5°±11.9° in ROM, 79.4±6.1, 77.3±4.0 and 73.0±7.2 in clinical KSS and 67.5±11.8, 69.0±10.4 and 60.8±11.0 in functional KSS, showing significant improvements in the above indexes between preoperation and postoperation ( P<0.05). The ROMs for the metal-polyethylene and metal-cement groups were significantly better than for the cement group ( P<0.05). A total of 32 patients completed stage-two revision, with 7 in the metal-polyethylene group, 12 in the metal-cement group and 13 in the cement group. Respectively, ROMs after stage-two revision were 104.6°±9.8°, 98.5°±8.7° and 86.1°±8.9°, clinical KSSs 85.3±4.6, 82.7±4.3 and 78.0±4.8 and functional KSSs 78.6±6.9, 77.3±8.2 and 69.5±8.3 for the metal-polyethylene, metal-cement and cement groups, showing significant improvements after stage-one revision ( P<0.05). The postoperative sonication fluid culture showed negative results in all. Conclusions:Articulating spacers can effectively control knee PJI and improve the knee function during revision interval and after revision. Metal spacers may lead to a better range of motion than traditional cement ones.

Effect of antibiotic prophylaxis before revision for periprosthetic joint infection on positive rate of intraoperative specimen culture / 中华创伤骨科杂志

Objective:To investigate whether the prophylactic use of a dose of sensitive antibiotics before revision for periprosthetic joint infection (PJI) may affect the positive rate of intraoperative specimen culture.Methods:This prospective study recruited the patients who underwent revision due to PJI from July 1, 2017 to February 1, 2019 at Department of Orthopaedics, The First Affiliated Hospital to Fujian Medical University. After use of antibiotics was stopped in all patients for 2 weeks before operation, synovial fluid was extracted for culture to confirm pathogenic bacteria and drug sensitivity and some/all of the prostheses were removed during operation. According to their sequence number of admission, the patients were randomly divided into group A and group B. Samples were taken in group A after a dose of sensitive antibiotics was administered 30 to 60 minutes before revision while a dose of sensitive antibiotics was given in group B after all samples were taken. Intra-operatively, synovial fluid, tissue grinding fluid (TGF) and ultrasonic prosthesis lysate (UPL) were taken for aerobic and anaerobic culture. According to whether there was a positive culture of at least one microbiological specimen, the preoperative and intraoperative culture results were analyzed and compared between the 2 groups.Results:A total of 32 PJI patients were included in this study due to positive culture of synovial fluid before operation, with 16 cases in group A and 16 in group B. The most common infection bacteria were staphylococci (59.3%, 19/32). There was no significant difference in age, gender, mode of operation, Tsukayama classification, prosthesis removal, preoperative ESR, CRP, synovial fluid white blood cell count (SF-WBC) or polymorphonuclear cell percentage (PMN) between the 2 groups. The positive rates of synovial fluid, tissue, TGF and UPL were 81.3% (13/16), 62.5% (10/16), 93.8% (15/16) and 93.8% (15/16) for group A, and 87.5% (14/16), 68.8% (11/16), 93.8% (15/16) and 100.0% (16/16) for group B, showing insignificant differences between the 2 groups ( P>0.05). The positive rates of TGF and UPL culture showed no significant difference between them in group A or in group B ( P>0.05), but they were significantly higher than those of traditional tissue culture ( P<0.05). Conclusions:As prophylactic use of antibiotics before PJI revision may not affect the positive rate of intraoperative specimen culture, it is not necessary to postpone use of prophylactic antibiotics before PJI revision. Furthermore, as positive rates of TGF and UPL culture are similar but significantly higher than those of traditional tissue culture, tissue grinding can be used to improve the positive rate of tissue culture.

Predictors of recovery of normal left ventricular ejection fraction in patients with chronic Keshan disease / 中华地方病学杂志

Objective:To explore the predictors of recovery of normal left ventricular ejection fraction (LVEF) in patients with chronic Keshan disease (CKD) after standard anti-heart failure treatment.Methods:From June 2013 to October 2017, CKD patients were selected as the research subjects in 8 Keshan disease counties (cities) in Shandong Province. Demographic data and clinical indicators related to the recovery of normal LVEF were collected at the initial diagnosis, and the patients were given standard anti-heart failure treatment. Follow-up was carried out until October 2019 or until all-cause death. Patients were divided into recovery group and non-recovery group according to whether LVEF returned to normal (LVEF≥50% was normal) by group design, and multi-factor logistic regression was used to analyze the predictors of recovery of normal LVEF.Results:A total of 98 CKD patients were included in this study, their average age was (47.51 ± 12.84) years old; body mass index (BMI) was (23.18 ± 4.92) kg/m 2; LVEF was (39.54 ± 8.26)%; male accounted for 65.31% (64/98); the New York Heart Association (NYHA) heart function grade Ⅱ and grade Ⅲ accounted for 46.94% (46/98) and 53.06% (52/98), respectively. The median follow-up time was 26 months, the LVEF of 28 patients (28.57%) returned to normal, and the LVEF increased from (43.27 ± 7.85)% of the baseline to (58.74 ± 6.07)%, the difference was statistically significant ( t=8.25, P < 0.01); LVEF did not return to normal in 70 patients (71.43%), and the LVEF increased from (37.84 ± 6.93)% of the baseline to (42.94 ± 7.31)%, the difference was statistically significant ( t=4.24, P < 0.01). The median recovery time of 28 patients with normal LVEF recovery was 14 months, of which 4 patients (14.29%), 6 patients (21.43%) and 15 patients (53.57%) recovered at follow-up of 6, 12 and 18 months, respectively, and 27 patients (96.43%) recovered within 3 years. The results of multivariate logistic regression analysis showed that disease course [odds ratio ( OR)=0.81, 95% confidence interval ( CI): 0.70-0.95, P < 0.05], electrocardiogram QRS wave duration ( OR=0.88, 95% CI: 0.79-0.98, P < 0.05), LVEF ( OR=1.26, 95% CI: 1.13-1.42, P < 0.01), and left ventricular end-diastolic diameter (LVEDD, OR=0.79, 95% CI: 0.66-0.90, P < 0.01) were independent predictors of recovery of normal LVEF. Conclusions:LVEF can return to normal after anti-heart failure treatment in some CKD patients. Patients with shorter disease course, shorter electrocardiogram QRS wave duration, higher baseline LVEF and lower LVEDD are more likely to recover from LVEF.

Advances in the metabolic engineering for the production of tetracarbon organic acids / 生物工程学报

Tetracarbon organic acids are important platform chemicals that are widely used in the food, chemical, medicine, material industries and agriculture. Compared with the traditional petrochemical process, the production of tetracarbon organic acids by microbial fermentation is more promising due to milder reaction conditions, greener process and better environmental compatibility. This review summarizes the biosynthetic pathways and metabolic mechanisms for the production of tetracarbon organic acids, and illustrates recent advances, challenges, and future perspectives in the production of tetracarbon organic acids by naturally selected or purposefully engineered strains.

Advances in the synthesis of biobutanol by consolidated bioprocessing from lignocellulose / 生物工程学报

Consolidated bioprocessing (CBP) is a multi-step process in a bioreactor, which completes hydrolase production, enzymatic hydrolysis, and microbial fermentation. It is considered to be the most promising process for the production of second-generation biofuels because of its simple steps and low cost. Due to the complexity of lignocellulose degradation and the butanol synthesis pathway, few wild microorganisms can directly utilize lignocellulose to synthesize butanol. With the development of synthetic biology, single-bacterium directly synthesizes butanol using lignocellulose by introducing a butanol synthesis pathway in the cellulolytic Clostridium. However, there are still some problems such as heavy metabolic load of single bacterium and low butanol yield. Co-culture can relieve the metabolic burden of single bacterium through the division of labor in different strains and can further improve the efficiency of butanol synthesis. This review analyzes the recent research progress in the synthesis of biobutanol using lignocellulose by consolidated bioprocessing from both the single-bacterium strategy and co-culture strategy, to provide a reference for the research of butanol and other biofuels.

Detection of periprosthetic joint infection pathogens by metagenomic next-generation sequencin / 中华骨科杂志

Objective@#To investigate and compare the capability of metagenomic next-generation sequencing (mNGS) in detecting pathogens and diagnosing of periprosthetic joint infection (PJI) from synovial fluid and sonicate fluid of patients who underwent revision arthroplasty.@*Methods@#Thirty-five consecutive patients who underwent revision arthroplasty from May 2018 to November 2018 were included prospectively. There were 22 males and 13 females, 11 hip revisions and 24 knee revisions. All the patients were divided into the PJI group and aseptic loosening (AL) group. Synovial fluid and sonicate fluid of the explanted prostheses were obtained for microbiological culture and mNGS tests. Periprosthetic tissues were only collected for culture. Synovial fluid of three patients undergoing primary arthroplasty been treated by sonication as the negative control group concurrently. Comparisons of microbiological results and diagnostic value from mNGS and culture tests were performed.@*Results@#In the 13 culture-positive PJI patients, mNGS results of synovial fluid were positive in 12 cases, while culture and mNGS results were completely consistent at species level in 7 cases, consistent at the genus level in 1 case. mNGS results of sonicate fluid were positive in 13 cases, while culture and mNGS results were completely consistent at species level in 9 cases, consistent at the genus level in 1 case. In 7 culture-negative PJI patients, 6 cases had consistent mNGS results at species level both from synovial fluid and sonicate fluid, however, one case had positive mNGS result only from sonicate fluid. All culture results and mNGS results of synovial fluid were negative in all 15 AL patients, however, mNGS results of sonicate fluid was positive in 1 AL case. Cultures and mNGS results were negative in all three pairs of negative-control samples. In all 70 samples, mNGS detected 24 pathogens in sonicate fluids and 22 pathogens in synovial fluids. There was no significant difference in number of raw reads and human reads ratio between mNGS of sonicate fluid and synovial fluid. mNGS of sonicate fluid generated significantly higher number of microbial reads and of stringently mapped reads of pathogen in species-level than that of synovial fluids. There was no significant difference in diagnostic sensitivity of PJI between mNGS of sonicate fluids and synovial fluids (90.0% vs 100.0%). Both of them were significantly higher than that of culture of synovial fluid, periprosthetic tissues. Diagnostic sensitivity of sonicate fluid mNGS was not significantly higher than that in culture of sonicate fluid (65%). The specificities were similar among various microbiological testing methods.@*Conclusion@#mNGS of either synovial fluid or sonicate fluid from patients who underwent revision arthroplasty can be used to detect the presence of pathogens effectively and diagnose PJI accurately. mNGS can identify more pathogens and generate a higher number of pathogenic reads from sonicate fluids than synovial fluid. mNGS of synovial fluids has met the clinical diagnostic demands for most PJI patients. mNGS of sonicate fluid could be applied in some cases.

Echocardiographic: a comparison of chronic Keshan disease between patients in plateau and plain areas / 中华地方病学杂志

Objective The echocardiography of patients with chronic Keshan disease (CKD) in the plateau and plain areas was compared,to analyze the specific manifestations of echocardiography in patients with high altitude CKD,to provide a reference for imaging diagnosis.Methods From October 2014 to December 2016,34 patients with CKD were selected in the Tibet Autonomous Region [18 males,16 females,aged (44.5 ± 5.6) years old] as plateau group;45 patients with CKD were selected in Shandong Province [21 males,24 females,age (47.3 ± 6.9) years old] as a plain group.Echocardiography was performed on the observed subjects,and cardiac morphology,hemodynamics and cardiac function were analyzed.Results The left atrial diameter (LAD),left ventricular end diastolic diameter (LVEDD),and left ventricular mass (LVM) of the plateau group were (39.2 ± 4.8),(56.5 ± 6.3) mm and (232.4 ± 40.2) g,respectively,which were lower than those of the plain group [(48.3 ± 5.7),(65.2 ± 7.8) mm,(283.7 ± 38.3) g,t =-7.52,-5.30,-5.74,P ＜ 0.01].The right atrial transverse diameter (RATD),right ventricular transverse diameter (RVTD) and right ventricular lateral wall thickness (RVWT) of the plateau group were (47.6 ± 8.5),(50.4 ± 7.3) and (4.8 ± 1.1) mm,respectively,which were higher than those of the plain group [(42.3 ± 7.2),(42.7 ± 6.8),(3.3 ± 0.7) mm,t =2.99,4.81,7.36,P ＜ 0.01].The early diastolic filling velocity (E),the early diastolic peak velocity of the mitral annular (Em) of the plateau group were lower than those of the plain group,E/Em of the plateau group was higher than that of the plain group (t =-2.64,-2.35,2.07,P ＜ 0.05).The fractional area change (FAC) of right ventricular,tricuspid annular plane systolic excursion (TAPSE) and tricuspid annular systolic velocity (S') of the plateau group [(24.9 ± 2.8)％,(13.2 ± 1.2) mm,(6.8 ± 1.0) cm/s] were lower than those of the plain group [(26.3 ± 3.2)％,(14.5 ± 1.3) rmm,(7.5 ± 1.2) cm/s,t =-2.02,-4.53,-2.74,P ＜ 0.05 or ＜ 0.01].The tricuspid annular diastolic velocity (e') of the plateau group was lower than that of the plain group,and tricuspid annular blood flow early diastolic filling velocity maximum (e)/e'was higher than that of the plain group (t =-2.07,2.09,P ＜ 0.05).The systolic pulmonary artery pressure (SPAP) of the plateau group [(48.5 ± 12.3) mmHg,1 mmHg =0.133 kPa] was higher than that of the plain group [(41.6 ± 13.3) mmHg,t =2.34,P ＜ 0.05].Conclusion Compared with CKD patients in plain area,CKD patients in plateau area have showed more obvious right heart enlargement and right ventricular failure,and combined with higher SPAP.

Anatomical basis of the V-Y advancement flap based on the dorsal carpal perforators / 中华显微外科杂志

Objective To provide anatomical basis for the design of the V-Y advancement flap and investigate the morphological characters of the dorsal carpal perforators.Methods From August,2017 to October,2018,30 sides aduh specimens of hand were perfused with red latex.The following contents were observed under surgical magnifier:①The origin,courses,branches,and distribution of the dorsal carpal perforators.②The characters of dorsal carpal perforators in agreement with the antebrachial and dorsal metacarpal vascular net.Results The dorsal carpal vascular network was composed of deep vascular network (bone and joint network) and superficial vascular network (fasciocutaneous network).The deep vascular network was located at the deep aspect of the extensor tendons and was commonly formed by dorsal carpal branch of radial artery,dorsal carpal branch of anterior interosseous artery,ascending branch of the dorsal carpal perforator from the deep palmar arch,and dorsal carpal branch of ulnar artery.The superficial vascular network was located on the surface of the extensor tendons and was mainly formed by dorsal carpal branch of radial artery,dorsal carpal branch of ulnar artery,dorsal carpal branch of anterior interosseous artery,radial and ulnar myocutaneous branches of posterior interosseous artery,and the perforators from the deep vascular network.The 3rd and 4th perforators puncturing out from the ulnar and radial margins of the extensor tendon had a constant occurrence rate (100％) with an outer diameter of (0.7±0.3) mm and (0.6±0.2) mm,respectively,and a length of (1.1±0.4) cm and (0.9±0.4) cm,respectively.They were divided into the ascending branch,descending branch,and collateral branch.And finally anastomosis with antebrachial and dorsal metacarpal perforators.Conclusion The V-Y advancement flap based on the dorsal carpal perforators can be a good choice for restoring the dorsal metacarpal defects.

Mid-term clinical outcomes and radiological results of anterior cervical surgery for Hirayama disease / 中华骨科杂志

Objective　To evaluate the effect of anterior cervical fusion or non-fusion surgery for the treatment of Hirayama disease.Methods　The patients with Hirayama disease who underwent anterior cervical surgery in our hospital from July 2008 to December 2015 were retrospectively enrolled in this study.These cases were divided into two groups:fusion group(11 cases)and non-fusion group(12 cases).In fusion group,there were 9 males and 2 females,with an average age of 17.92±0.61 years(range,15-29).In the non-fusion group,there were 10 males and 1 female,with an average age of 19.18±1.14 years(range,15-23).Muscle strength,muscular atrophy,and the Michigan score for hand function were compared between the two groups preoperatively and postoperatively.The indexes such as arc cervical physiological curvature index,the maximum flexion angle,the maximal range of motion(ROM),flexion ROM of adjacent segments of lower(cervical vertebra were measured from the X-ray of the two groups,and the cross-sectional area of spinal cord was measured and compared on neutral position MRI.Results　There were no significant differences between the two groups in grip strength,preoperative hand function Michigan score,cervical physiological(curvature index,the maximum flexion angle,the maximal ROM,flexion ROM of adjacent segments of lower cervical vertebra,and cross-sectional area of spinal cord on neutral position MRI(P>0.05).Patients in fusion group were followed up for 38-103 months with an average of 59.73±5.57 months,while patients in non-fusion group were followed up for 40-95 months with an aver-age of 56.25±4.57 months.Clinical outcomes:At the last follow-up,the finger tremor and cold paralysis were alleviated in all patients,but the symptoms in fusion group and non-fusion group were not completely disappeared in 2 and 3 cases,respectively.The grip strength of fusion group(preoperative 17.14±6.09,postoperative 17.47±5.64)and the non-fusion group(preoperative 17.75±5.49,postoperative 17.40±4.58)were not significantly improved compared with preoperative(P>0.05).The Michigan score for hand function of fusion group(preoperative 10.27±0.41,postoperative 6.64±0.24)and the non-fusion group(preoperative 9.25±0.35,postoperative 6.83±0.24)were significantly improved compared with preoperative(P<0.05).There was no significant difference in postoperative Michigan score between the two groups(P>0.05).Radiological outcomes:The cervical physiological curvature index and cross-sectional area of the spinal cord of the two groups increased after operation,while the maximum flexion angle,the maximal ROM decreased.There was no significant difference in these indexes between the two groups postoperatively(P>0.05).The spinal cord had no compression on flexion MRI.The cross-sectional area of C4-C7 spinal cord in Neutral MRI were significantly increased at C6 and C7 levels in both groups.There was no significant difference in the cross-sectional area of C4-C7 spinal cord between the two groups postoperatively(P>0.05).Two cases of internal fixation loosening occurred in non-fusion group 3 years after the operation,while there were no cases of loosening in the fusion group.Conclusion　Anterior cervical fusion or nonfusion surgery can limit excessive cervical kyphosis in patients with Hirayama disease,reduce atrophy of compressed cervical spinal cord,and alleviate the disease progress of muscular atrophy of the distal upper limb.It can be selected as a treatment method for Hirayama disease.However,there is a risk of internal fixation loosening in non-fusion cases,and also a risk of adjacent segment degeneration in fusion cases.The appropriate cases should be selected carefully for surgery.

Application of next generation sequencing technology in the detection of pathogenic bacteria in synovial fluid of prosthetic joint infection / 中华骨科杂志

Objective To investigate the role of next generation sequencing technology in the detection of pathogenic bacteria in synovial fluid of prosthetic joint infection.Methods Nine samples of synovial fluid specimens of prosthetic joint infection patients with positive microbial culture from October,1 2016 to April 1,2017 were collected.Each specimen (200 μl) was used for next generation sequencing.Total DNA was extracted from synovial fluid samples.The collected DNA samples were amplified by PCR in the V4 region of 16S rDNA gene.The amplified products were sequenced using the Illumina Miseq platform,2× 250 bp double-end sequencing strategy.The sequencing results were compared with the SILVA database to analyze the types of bacteria and relative abundance in the DNA samples.A total of 200 μl sterile double-distilled deionized water was used as control.Results Nine cases of microbial culture positive prosthetic joint infection synovial fluid DNA samples were sequenced by 16S rDNA amplicon sequencing and yielded 3 132 415 high-quality reads and 3 752 operational taxonomic units (OTU).At the level of bacteria,a total of 9 different bacterial gates were detected on 9 DNA samples.At the level of bacteria,34 different bacteria were detected by 16S rDNA amplicon sequencing.Each DNA sample was detected by 16S rDNA amplicon sequencing and the bacterial genus was identical to that of laboratory culture.16S rDNA amplicon sequencing detected more species of bacteria [6(3,9.5)] than bacterial cultures [(1.0(1.0,1.0)].There was statistically significant difference in the number of bacteria detected in the same specimen between the 16S rDNA amplicon sequencing and the laboratory culture (Z=2.533,P=0.011).Among them,the dominant bacterial population (highest abundance) detected by 16S rDNA amplicon sequencing in four DNA samples was consistent with the results of laboratory culture.Conclusion In the prosthetic joint infection,the 16S rDNA amplicon sequencing technology can accurately detect pathogens that are consistent with the laboratory culture,and can detect other bacteria outside the laboratory culture.This technology can provide the basis for clinical diagnosis and antibiotic selection.

Eukaryotic translation elongation factor 1A1 positively regulates NOB1 expression to promote invasion and metastasis of hepatocellular carcinoma cells / 南方医科大学学报

<p><b>OBJECTIVE</b>To explore the role of eukaryotic translation elongation factor 1A1 (eEF1A1) in regulating the invasion and metastasis of hepatocellular carcinoma (HCC) cells and the possible mechanism.</p><p><b>METHODS</b>qRT-PCR and Western blotting were used to detect the mRNA and protein expression of eEF1A1 and NOB1 in different HCC cell lines and normal liver cells. The invasion and migration abilities of HCC cells with eEF1A1 knockdown or overexpression were examined using Transwell chamber assay and RTCA assay, and the changes in NOB1 mRNA and protein expressions in the cells were detected. The effects of increasing NOB1 expression in HCCLM3-sheEF1A1 cells and decreasing NOB1 expression in eEF1A1-overexpressing MHCC97h cells on eEF1A1 expression and cell invasion and migration abilities were analyzed using Western blotting, Transwell chamber assay and RTCA assay.</p><p><b>RESULTS</b>The expressions of eEF1A1 and NOB1 were significantly increased in positive correlation in HCC cells as compared with normal hepatocytes. Knockdown of eEF1A1 significantly decreased the invasion and migration of HCC cells and reduced the mRNA and protein expression of NOB1 ( < 0.01). Overexpression of eEF1A1 significantly enhanced invasion and migration of HCC cells and increased NOB1 mRNA and protein expressions ( < 0.01). Increasing NOB1 expression in HCCLM3-sheEF1A1 cells led to the restoration of NOB1 expression and cell invasion and migration abilities ( < 0.01), whereas decreasing NOB1 in MHCC97h-eEF1A1 cells resulted in inhibition of NOB1 expression and cell invasion and migration ( < 0.01).</p><p><b>CONCLUSIONS</b>eEF1A1 positively regulates the expression of NOB1 to promote the invasion and migration of HCC cells .</p>