Research Progress in the Mechanism of TCM for Regulating JAK/STAT Signaling Pathway in Intervention of Myocardial Ischemia-reperfusion Injury / 中国中医药信息杂志

Acute myocardial infarction(AMI)is a common cardiovascular emergency in clinic.Early reperfusion is a typical and effective method for the treatment of AMI.However,the recovery of blood supply after reperfusion therapy will accelerate the damage of ischemic myocardium and cause myocardial ischemia-reperfusion injury(MI/RI).In recent years,studies have found that TCM has the unique advantages of multi-component,multi-channel and multi-target in the intervention of MI/RI.Janus tyrosine kinase/signal transducer and activator of transcription(JAK/STAT)signaling pathway is closely related to MI/RI,which can reduce MI/RI process by regulating inflammation,oxidative stress,cell proliferation,differentiation and apoptosis.This article reviewed the mechanism of JAK/STAT signaling pathway in MI/RI and the research of TCM targeting this pathway,in order to provide references for the prevention and treatment of MI/RI and further drug development.

Research Progress in the Mechanism of Astragaloside Ⅳ Against Myocardial Injury / 中国中医药信息杂志

Myocardial injury is a pathological change of myocardium caused by many factors,which can lead to the decline of cardiac function and the occurrence of cardiovascular events.Astragaloside Ⅳ is one of the main pharmacological components in Astragali Radix,which plays an anti-myocardial injury role by regulating various signaling pathways.This article reviewed the anti-myocardial injury mechanism of astragaloside Ⅳ from five aspects:inhibition of oxidative stress,inhibition of apoptosis,anti-myocardial fibrosis,improvement of myocardial energy metabolism and inhibition of myocardium inflammation,in order to provide reference for the mechanism research and clinical application of astragaloside Ⅳ in the prevention and treatment of myocardial injury.

Traditional Chinese Medicine Intervention in Rheumatoid Arthritis-related Signaling Pathways： A Review / 中国实验方剂学杂志

Rheumatoid arthritis （RA）， as an autoimmune disease， is mainly characterized by persistent synovitis. It often involves multiple joints symmetrically and can lead to joint deformity， joint function loss， and even disability in severe cases. The pathogenesis of RA is complex， and the prevention and treatment are complicated. Therefore， it is difficult to cure the disease completely. Previous studies have validated important targets and mechanisms for the prevention and treatment of RA， including the nuclear factor-κB （NF-κB） signaling pathway that controls the inflammatory process， nuclear factor E2-related factor 2 （Nrf2）/heme oxygenase-1 （HO-1） signaling pathway that regulates oxidative stress， inhibits inflammation， and maintains cell homeostasis， Wnt/β-catenin signaling pathway that plays a key role in cell growth， differentiation， apoptosis， and inflammatory response， anti-inflammatory， anti-oxidation， and silent information regulator 1 （SIRT1） signaling pathway that regulates synovial cells， anti-inflammatory adenylate-activated protein kinase （AMPK） signaling pathway that regulates energy metabolism， and hypoxia-inducible factor-1α （HIF-1α）/vascular endothelial growth factor （VEGF） signaling pathway related to angiogenesis in RA. At the same time， many studies have confirmed that traditional Chinese medicine prevents and treats RA by regulating the above signaling pathways and exerting their related effects， indicating the advantages of traditional Chinese medicine such as multiple regulatory pathways， long-term effects， and less adverse reactions. In this paper， by consulting many research reports， the role of the above-mentioned signaling pathways in RA was clarified， and the latest research results of traditional Chinese medicine intervention in the above-mentioned signaling pathways in the prevention and treatment of RA in recent years were summarized in detail. This paper aims to promote the in-depth study of the pathogenesis of RA and its treatment with traditional Chinese medicine， provide a scientific basis for the rational application of traditional Chinese medicine， and offer useful enlightenment for the development of new drugs and clinical practice for the treatment of RA in the future.

Hypoxia inducible factor-1α related mechanism and TCM intervention in process of early fracture healing / 中草药·英文版

As a common clinical disease, fracture is often accompanied by pain, swelling, bleeding as well as other symptoms and has a high disability rate, even threatening life, seriously endangering patients' physical and psychological health and quality of life. Medical practitioners take many strategies for the treatment of fracture healing, including Traditional Chinese Medicine (TCM). In the early stage of fracture healing, the local fracture is often in a state of hypoxia, accompanied by the expression of hypoxia inducible factor-1α (HIF-1α), which is beneficial to wound healing. Through literature mining, we thought that hypoxia, HIF-1α and downstream factors affected the mechanism of fracture healing, as well as dominated this process. Therefore, we reviewed the local characteristics and related signaling pathways involved in the fracture healing process and summarized the intervention of TCM on these mechanisms, in order to inspirit the new strategy for fracture healing, as well as elaborate on the possible principles of TCM in treating fractures based on the HIF molecular mechanism.

Analysis of characteristics and risk factors of bacterial infection in patients undergoing liver transplantation for liver failure / 中华消化外科杂志

Objective:To analyze the pathogens distribution, drug resistance and risk factors of bacterial infection in patients undergoing liver transplantation for liver failure.Methods:The retrospective case-control study was conducted. The clinical data of 88 patients with liver failure who underwent liver transplantation in The First Affiliated Hospital of Xi′an Jiaotong University from July 2020 to June 2023 were collected. There were 57 males and 31 females, aged (44±9)years. Observation indicators:(1) incidence and pathogens distribution of bacterial infection in patients undergoing liver transplantation for liver failure; (2) drug resistance of bacteria; (3) risk factors of bacterial infection in patients undergoing liver transplantation for liver failure. Measurement data with normal distribution were represented as Mean± SD. Measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers and percentages. Univariate analysis was conducted using the chi-square test or Fisher exact probability. Multivariate analysis was conducted using the Logistic regression model. Results:(1) Incidence and pathogens distribution of bacterial infection in patients undergoing liver transplantation for liver failure. Of 88 patients, 40 cases had bacterial infection after liver transplantation, with the incidence as 45.45% and occurrence time as postoperative 18(range, 1-57)days. Of the 40 cases with bacterial infection after liver transplantation, 9 cases had single strain infection and 31 cases had mixed bacterial infection. A total of 135 strains of different pathogenic bacteria were isolated from 40 patients, 106 of which were Gram-negative bacteria, 29 were Gram-positive bacteria. Of the Gram-negative bacteria, the top 4 pathogenic bacteria were 37 strains of Acinetobacter baumannii, 35 strains of Klebsiella pneumoniae, 11 strains of Pseudomonas aeruginosa, 9 strains of Stenotrophomonas maltophilia. Of the Gram-positive bacteria, there were 22 strains of Enterococcus faecium, 3 strains of Staphylococcus aureus, 3 strains of Staphylococcus epidermidis, 1 strain of Staphylococcus haemolyticus. Of the 135 strains of pathogenic bacteria, 64 strains were isolated from respiratory tract, 26 strains were from abdomen, 23 strains were from biliary tract, 16 strains were from blood, 6 strains were from other sites. (2) Drug resistance of bacteria. Of the Gram-negative bacteria, Acinetobacter baumannii had a resistance rate of lower than 30.0% to colistin, tigacyclinei, minocycline, a resistance rate of 30.0%-50.0% to amikacin and tobramycin, a resistance rate of over 70.0% to cefotetan, ceftazidime, cefepime, cefoperazone/sulbactam, piperacillin/tazobactam, meropenem, imipenem, ciprofloxacin, cotrimoxazole, levofloxacin. Klebsiella pneumoniae showed a resistance rate of lower than 30.0% to ceftazidime/avibactam, colistin, tigacyclinei and a resistance rate of more than 70.0% to other tested antibiotics. Pseudomonas aeruginosa showed a resistance rate of more than 50.0% to meropenem, imipenem, levofloxacin and a resistance rate of lower than 50.0% to other tested antibiotics. Stenotrophomonas maltophilia showed a resistance rate of lower than 30.0% to cotrimoxazole, levofloxacin, minocycline. Klebsiella oxytoca showed a resistance rate of more than 50.0% to piperacillin/tazobactam, cefoperazone/sulbactam and a resistance rate of lower than 50.0% to other tested antibiotics. The resistance rate of Escherichia coli to amikacin, tobramycin, ceftazidime/avibactam, colistin, and tigecycline was less than 30.0%, and the resistance rate to other tested antibiotics was more than 50.0%. Of the Gram-positive bacteria, Staphylococcus aureus showed a resistance rate of 0 to tigacyclinei, vancomycin, teicoplanin, linezolid, a resistance rate of lower than 50.0% to gentamicin and ciprofloxacin, and a resistance rate of more than 50.0% to erythromycin, penicillin G, ampicillin, tetracycline, levofloxacin. Staphylococcus showed a resistance rate of more than 50.0% to erythromycin, penicillin G, oxacillin, and a resistance rate of 0 to other tested antibiotics. (3) Risk factors of bacterial infection in patients undergoing liver transplantation for liver failure. Results of multivariate analysis showed that preoperative model for end-stage liver disease score ≥30 was an independent risk factor for bacterial infection in patients undergoing liver transplantation for liver failure ( odds ratio=6.440, 95% confidence interval as 2.155-19.248, P<0.05). Conclusions:The incidence of bacterial infection in patients undergoing liver transplantation for liver failure is high, with the most common sites of respiratory tract and abdomen. The pathogenic bacteria are mainly Gram-negative bacteria, which show an extensive and high drug resistance. Preoperative model for end-stage liver disease score ≥30 was an independent risk factor for bacterial infection in patients undergoing liver transplantation for liver failure.

Study on the mechanism of biomechanical stress rebalancing at the bone tissue-bone cement interface after reinforcement of osteoporotic vertebral compression fracture based on finite element method / 中国脊柱脊髓杂志

Objectives:To clarify the biomechanical stress rebalancing mechanism at the bone tissue-cement interface and the dynamic stability reconstruction effect on the spine after cement reinforcement treatment of osteoporotic vertebral compression fractures(OVCF).Methods:An OVCF patient(injured vertebrae,T12 and L1)treated in the Department of Spine Surgery of the Affiliated Hospital of Gansu University of Traditional Chinese Medicine was selected as the object of study,and thin-layer,high-precision thoracic and lumbar vertebral CT imaging data of the patient was extracted.A 3D digitally simulated biomechanical model was established through the finite-element biomechanical modeling platforms of Mimics,Geomagic,Solidworks,and Ansys Workbench,in order to quantitatively study the equivalent stress at bone tissue-cement interface of motion segment of the injured vertebral body under different motion conditions such as axial,flexion,extension,lateral bending,and rotation.Results:The extreme value and distribution range of equivalent stress at the bone tissue-bone cement interface after spinal OVCF were significantly optimized compared with those before surgery.Under the motion conditions of axial,forward flexion,posterior extension,lateral bending and rotation conditions,the maximum principal stress after spinal cement reinforcement for T12 vertebra decreased significantly compared with that before surgery,which was 33.002MPa,35.639MPa,35.98MPa,60.458MPa,65.396MPa,60.177MPa,and 42.249MPa under the same working conditions,especially under the forward flexion working conditions,the maximum principal stress of T12 decreased from 77.995MPa before surgery to 35.639MPa after surgery;Under the same motion conditions,the maximum principal stress of L1 vertebra after reinforcement treatment was 24.91 1MPa,34.705MPa,26.514MPa,60.144MPa,32.797MPa,30.259MPa,and 32.894MPa,respectively,and under axial and foiward flexion conditions,the maximum principal stress of L1 vertebra decreased from 74.798MPa and 99.232MPa before surgery to 24.911 MPa and 34.705MPa after surgery.The maximum principal stress at T12 and L1 bone cement interface distributed evenly.The extreme value of principal stress at T12 cancellous bone was 1.004MPa to 3.0758MPa,which at L1 cancellous bone was 1.8075MPa to 2.3355MPa.The stress distribution cloud map showed that the stress distribution at hone interface shifted to the middle and posterior columns after the reinforcement treatment,and the stress concentration was corrected.The stress distribution at the bone tissue-bone cement interface tended to be balanced and stabilized.Conclusions:The dynamic biomechanical stability of the spine is reconstructed after cemented reinforcement of the injured vertebrae in the thoracolumbar segment,and the biomechanical stress-strain stimulus at the bone tissue-cement interface is significantly decreased compared with the preoperative period,and the stresses are distributed evenly,which reconstruct the stress rebalancing at the bone tissue-cement interface.

Chinese expert consensus on the technical standard of direct anterior hip arthroplasty for elderly femoral neck fracture (version 2023) / 中华创伤杂志

Femoral neck fracture (FNF) in the elderly patients is currently a major health challenge worldwide, with excessive consumption of medical resources, high incidence of complications as well as suboptimal outcome and prognosis. Hip joint arthroplasty (HJA) has been the mainstream treatment for FNF in the elderly, but the conventional surgical approaches and techniques are still confronted with a series of bottlenecks such as dislocation, limp and limb length discrepancy. In recent years, direct anterior approach (DAA) for HJA (DAA-HJA) has been a major new choice in the field of joint replacement, which achieves improved clinical effectiveness of HJA in the treatment of elderly FNF, due to the fact that DAA approach involves the neuromuscular interface and accords with the idea of soft tissue retention and enhanced recovery after surgery. However, there is still a lack of unified understanding of standard technique and procedure of DAA-HJA in the treatment of elderly FNF. Therefore, relevant experts from the Hip Joint Group of Chinese Orthopedics Association of Chinese Medical Association, Youth Arthrology Group of Orthopedic Committee of PLA, Orthopedic Committee of Chongqing Medical Association, Branch of Orthopedic Surgeons of Chongqing Medical Doctor Association and Sport Medicine Committee of Chongqing Medical Association were organized to formulate the " Chinese expert consensus on the technical standard of direct anterior hip arthroplasty for elderly femoral neck fracture ( version 2023)" based on evidence-based medicine. This consensus mainly proposed 13 recommendations covering indications, surgical plans, prosthesis selections, surgical techniques and processes, and postoperative management of DAA-HJA in elderly patients with FNF, aiming to promote standardized, systematic and patient-specific diagnosis and treatment to improve the functional prognosis of the patients.

The diagnostic value of some inflammatory markers for knee joint periprosthetic joint infection / 中华骨科杂志

Objective:To investigate the diagnostic value of erythrocyte sedimentation rate/C-reactive protein (ECR), fibrinogen and D-dimer in periprosthetic infection after artificial knee replacement.Methods:A total of 205 patients, including 62 males and 143 females, aged 66.9±9.5 years (range 26-84 years), who underwent revision of artificial knee joint at Department of Joint Surgery, The First Affiliated Hospital of Xinjiang Medical University from January 2017 to December 2021 were retrospectively collected.122 cases of periprosthetic joint infection (PJI), including 43 cases of acute infection; 79 cases of chronic infection (13 cases of chronic infection combined with rheumatoid arthritis were analyzed separately); there were 83 cases without PJI, including 73 cases of aseptic loosening, 8 cases of prosthesis dislocation and 2 cases of joint stiffness. Erythrocyte sedimentation rate, C-reactive protein, white blood cell count, fibrinogen and D-dimer levels were examined before surgery, and the sensitivity and specificity of the indicators were calculated using the receiver operating characteristic (ROC) curve. The diagnostic value of different inflammatory markers was compared according to the area under curve (AUC).Results:The levels of ECR, erythrocyte sedimentation rate, C-reactive protein, fibrinogen, and D-dimer in acute PJI group were 2.47±2.91, 50 (38, 62) mm/1 h, 31.6 (13.9, 79.3) mg/L, 4.25±0.94 g/L, 763 (453, 1 157) ng/ml, respectively. The chronic PJI group was 3.06±2.95, 50 (34, 64) mm/1 h, 20.4(12.7, 43.3) mg/L, 4.19±0.91 g/L, 586 (317, 1 122) ng/ml, and the non-PJI group was 6.20±4.64, 22 (15, 34) mm/1 h, 4.6 (2.7, 7.74) mg/L, 3.10±0.59 g/L and 363 (181, 591)ng/ml were statistically significant ( P<0.05). The AUC of ECR, erythrocyte sedimentation rate, C-reactive protein, fibrinogen, and D-dimer in the acute PJI group were 0.82, 0.85, 0.90, 0.88, and 0.76, respectively.The optimal critical values were 2.89, 37.00 mm/1 h, 13.6 mg/L, 3.86 g/L, and 443.0 ng/ml, respectively, with sensitivity of 76.7%, 79.1%, 76.7%, 69.8%, and 82.4%, and specificity of 79.5%, 78.3%, 94.0%, 94.0%, 90.4%, and 63.8%, respectively. The AUC of ECR, erythrocyte sedimentation rate, C-reactive protein, fibrinogen, D-dimer, and white blood cell count in the chronic PJI group were 0.77, 0.82, 0.87, 0.85, 0.67, and 0.63, respectively. The optimal critical values are 2.91, 33.00 mm/1 h, 10.9 mg/L, 4.01 g/L, 558.5 ng/ml, and 5.575×10 9 /L, respectively, with sensitivity of 68.2%, 78.8%, 81.8%, 63.6%, 57.9%, and 75.8%, and specificity of 79.5%, 73.5%, 88.0%, 95.2%, 72.5%, and 49.4%, respectively. Conclusion:Fibrinogen has a higher diagnostic value for knee joint PJI, followed by ECR, and D-dimer has the lowest diagnostic value for knee joint PJI.

Gender differences in serological indicators for the diagnosis of chronic periprosthetic infections / 中华骨科杂志

Objective:To investigate the gender differences in serum C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), platelet (PLT), fibrinogen (FIB) and D-dimer for the diagnosis of chronic periprosthetic joint infection (PJI).Methods:A total of 470 patients who underwent revision arthroplasty in the Department of Joint Surgery, First Affiliated Hospital of Xinjiang Medical University from January 2013 to December 2021 were retrospectively analyzed. According to gender and diagnosis, they were divided into four groups: 78 cases of male chronic PJI, 108 cases of male aseptic loosening, 95 cases of female chronic PJI, and 189 cases of female aseptic loosening. The serological results of CRP, ESR, PLT, FIB and D-dimer were collected before operation. The receiver operating characteristics (ROC) curves were used to determine the optimal cut-off values of CRP, ESR, PLT, FIB and D-dimer for the diagnosis of chronic PJI in different genders, and to calculate their sensitivity and specificity. The diagnostic efficacy of the index was analyzed by comparing the area under curve (AUC) of different indicators.Results:The levels of ESR, PLT and D-dimer in the male chronic PJI group were 43 (20.0, 52.5) mm/1 h, 249×10 9 (204×10 9, 306×10 9) /L, 449 (219,833) μg/L, respectively, which were lower than those in the female group of 56 (40, 65) mm/1 h, 295×10 9 (228×10 9, 364×10 9) /L, and 645 (345, 1 157) μg/L, with statistically significant differences ( Z=-4.17, P<0.001; Z=-2.17, P=0.030; Z=-2.82, P=0.005). The AUC of CRP in the male chronic PJI group was 0.841, which was higher than the AUC of the other four indicators; CRP was combined with ESR, PLT, FIB and D-dimer to establish a joint prediction model for male chronic PJI. The ROC curve showed that the combination of CRP+FIB had a maximum AUC [0.849, 95% CI (0.79, 0.91)], sensitivity of 80% and specificity of 86%. The AUC of CRP in the female chronic PJI group was 0.866, which was higher than the AUC of the other four indices; CRP was combined with ESR, PLT, FIB and D-dimer to establish a combined prediction model for female chronic PJI. The ROC curve showed that the combination of CRP+PLT had the maximum AUC [0.883, 95% CI (0.84, 0.93)], sensitivity of 87% and specificity of 79%. Conclusion:Serologic indicators in patients with chronic PJI are gender-specific. CRP combined with FIB has the highest diagnostic value for the chronic PJI in males, while CRP combined with PLT has the highest diagnostic value for the chronic PJI in females.

Diagnostic value of plasma fibrinogen in chronic periprosthetic infection / 中华骨科杂志

Objective:To investigate the diagnostic value of plasma fibrinogen (FIB) in chronic periprosthetic joint infection (PJI).Methods:A total of 470 patients who underwent revision hip and knee arthroplasty after primary hip and knee arthroplasty in the First Affiliated Hospital of Xinjiang Medical University from January 2013 to December 2021 were retrospectively analyzed. According to the diagnosis of the disease, 173 patients (112 hips and 61 knees) were divided into chronic PJI group, including 78 males and 96 females, aged 65 (53, 72) years; and 297 patients (216 hips and 81 knees) were divided into aseptic loosening group, including 108 males and 189 females, aged 63 (50, 72) years. The preoperative levels of FIB, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), D-dimer and platelet were compared between the two groups, and the sensitivity and specificity of the diagnosis of chronic PJI were calculated. Receiver operating characteristic (ROC) curves were used to determine the optimal cut-off values of FIB, CRP, ESR, platelet and D-dimer for the diagnosis of chronic PJI. The diagnostic efficacy of each indicator was analyzed by comparing the area under curve (AUC) and using a combined diagnostic test.Results:FIB, CRP, ESR, platelets and D-dimer in the chronic PJI group were 4.05 (3.52, 4.72) g/L, 19.5 (10.7, 40.0) mg/L, 50 (28, 60) mm/1 h, 270 (221, 351)×10 9 /L, 514 (261, 873) μg/L, respectively, which were higher than 3.25 (2.80, 3.63) g/L, 3.7 (2.0, 6.7) mg/L, 20 (12, 30) mm/1 h, 225 (182, 269)×10 9 /L, and 310 (167, 569) μg/L in sterile loosening group, with statistically significant differences ( P<0.05). The AUC of FIB, CRP, ESR, platelets and D-dimer in the diagnosis of chronic PJI were 0.78 (95% CI: 0.73, 0.82), 0.86 (95% CI: 0.82, 0.89), 0.80 (95% CI: 0.76, 0.85), 0.68 (95% CI: 0.63, 0.73), 0.64 (95% CI: 0.59, 0.69); the optimal cut-off values were 3.73 g/L, 9.64 mg/L, 39 mm/1 h, 280×10 9 /L, 624 μg/L; the sensitivity was 68%, 79%, 69%, 47%, 43%; the specificity was 81%, 85%, 85%, 81%, 79%, respectively. When CRP, ESR, FIB, platelets and D-dimer were combined sequentially to diagnose patients with chronic PJI, the sensitivity and specificity of the series test were 12.7% and 99.7%, and those of the parallel test were 100% and 37.3%. The combined diagnostic test showed that the maximum AUC of FIB combined with CRP was 0.85 (95% CI: 0.81, 0.89), with a sensitivity of 76% and a specificity of 89%. Conclusion:The clinical value of plasma FIB in the diagnosis of chronic PJI is not superior to that of CRP and ESR, but the combination of FIB and CRP can improve the specificity.

Analysis of risk factors for failure in the treatment of early periprosthetic joint infection by debridement, antibioticsand implant retention combined with intra-articular injection of antibiotics / 中华骨科杂志

Objective:To analyze the risk factors leading to the failure of early periprosthetic joint infection (PJI) treated by debridement, antibiotics and implant retention (DAIR) combined with intra-articular injection of antibiotics.Methods:A total of 100 patients who received DAIR combined with intra-articular injection of antibiotics between January 2010 and October 2020 in the Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, were retrospectively analyzed. There were 47 males and 53 females, with an average age of 62.8±13.0 years (26-84 years). 75 patients were diagnosed as PJI after primary surgery while 25 PJI after revision or debridement, involving 41 hips and 59 knees. According to the clinical outcomes, the patients were divided into the cured group (78 cases) and the uncured group (22 cases). Risk factors were screened by univariate analysis on their gender, age, body mass index, site of infection (hip/knee), synovial white blood cell count, erythrocyte sedimentation rate (ESR), C reactive protein (CRP), time of infection, types of pathogenic bacteria (gram-positive bacteria, gram-negative bacteria or fungi), preoperative sinus tract and previous surgical history. For the factors with P<0.20, multivariate binary logistic regression analysis was performed to determine the independent risk factors. Kaplan-Meier survival curve was drawn and any cause that led to treatment failure was seen as the end point event. Calculate prosthetic survival time and 10-year survival rate. Results:The average follow-up was 59.8±40.6 months (0.3-129.0 months). The infection control rate of DAIR combined with intra-articular injection of antibiotics in the treatment of early PJI was 78% (78/100). The univariate analysis showed that the successful rate of non-fungal infection group (81%, 77/95) was significantly higher than the fungal infection group (20%, 1/5) and the successful rate of the group without previous surgical history (85.3%, 64/75) was significantly higher than that with previous surgical history (56.0%, 14/25, χ 2=7.07, P=0.008; χ 2=9.40, P=0.002). The multivariate binary Logistic regression analysis showed that fungal infection [ OR=0.08, 95% CI(0.01, 0.79), P=0.031] and history of previous surgical intervention [ OR=0.25, 95% CI(0.09, 0.73), P=0.001] were independent risk factors for treatment failure. Kaplan-Meier survival curves showed that the survival time of the prosthesis was 96.83±5.30 months, and the 10-year survival rate was 68.1%. Meanwhile, the survival rate of patients with fungal infection and previous surgical history was significantly lower than that of patients without fungal infection or previous surgical history, the difference was statistically significant (χ 2=15.49, P<0.001; χ 2=8.91, P=0.030). Conclusion:The time of PJI, bacterial virulence and species, and preoperative inflammatory indicators had no effect on the outcome of DAIR combined with intra-articular injection of antibiotics in the treatment of early PJI. However, DAIR was not recommended for patients with a history of surgical intervention and fungal infection.

Biomechanical Study on Contiguous Three-Level Cervical Hybrid Surgery and Anterior Cervical Discectomy and Fusion / 医用生物力学

Objective To compare the biomechanical effects of contiguous three-level cervical Hybrid surgery[anterior cervical discectomy and fusion (ACDF) + cervical disc arthroplasty ( CDA)] and three-level ACDF. Methods The finite element model of C1-T1 cervical-thoracic spine was developed based on CT data. Three models were simulated by the implantation of Prestige LP and Zero-P prostheses, including two Hybrid models (AFA, Prestige LP implanted at C3-4 and C5-6 segments and Zero-P implanted at C4-5 segment; FAF, Zero-P implanted at C3-4 and C5-6 segments and Prestige LP implanted at C4-5 segment) and three-level ACDF model(FFF). The changes in range of motion (ROM) of adjacent levels during flexion, extension, lateral bending and axial rotation, the overall ROM, as well as the intradiscal pressure ( IDP) and facet contact force ( FCF) of adjacent levels were compared. Results The ROM in adjacent levels and the overall ROM of the AFA modelwere closer to the intact model, and the maximum increases in the ROM of the adjacent levels for the FAF and FFF models were 15. 0% and 23. 4% , respectively. For AFA, FAF and FFF models, the maximum increases in the maximum IDP of adjacent levels were 19. 0% , 66. 7% , 147. 6% , and the maximum increases in FCF were 17. 4% , 55. 7% , 80. 1% , respectively. Conclusions This study provides biomechanical basis for three-level cervical Hybrid surgery in treating patients with the contiguous three-level cervical degenerative disc disease.

Three-dimensional reconstruction of femur based on Laplace operator and statistical shape model / 生物医学工程学杂志

Reconstructing three-dimensional (3D) models from two-dimensional (2D) images is necessary for preoperative planning and the customization of joint prostheses. However, the traditional statistical modeling reconstruction shows a low accuracy due to limited 3D characteristics and information loss. In this study, we proposed a new method to reconstruct the 3D models of femoral images by combining a statistical shape model with Laplacian surface deformation, which greatly improved the accuracy of the reconstruction. In this method, a Laplace operator was introduced to represent the 3D model derived from the statistical shape model. By coordinate transformations in the Laplacian system, novel skeletal features were established and the model was accurately aligned with its 2D image. Finally, 50 femoral models were utilized to verify the effectiveness of this method. The results indicated that the precision of the method was improved by 16.8%-25.9% compared with the traditional statistical shape model reconstruction. Therefore, the method we proposed allows a more accurate 3D bone reconstruction, which facilitates the development of personalized prosthesis design, precise positioning, and quick biomechanical analysis.

Effectiveness of one-stage total knee arthroplasty in treatment of advanced active knee tuberculosis / 中国修复重建外科杂志

OBJECTIVE@#To investigate the effectiveness of one-stage total knee arthroplasty (TKA) in the treatment of advanced active knee tuberculosis.@*METHODS@#The clinical data of 38 patients with advanced active knee tuberculosis who received one-stage TKA between January 2011 and December 2020 were retrospectively analyzed. There were 20 males and 18 females. The age ranged from 20 to 84 years, with an average of 52.8 years. The body mass index ranged from 17 to 36 kg/m 2, with an average of 23.05 kg/m 2. The preoperative C reactive protein (CRP) was (23.49±4.72) mg/L, erythrocyte sedimentation rate (ESR) was (45.95±8.82) mm/1 h. The Hospital for Special Surgery (HSS) score was 48.8±9.1. During the operation, the infected lesions of the knee joint were completely removed, and the operative area was repeatedly soaked with 3% hydrogen peroxide solution and 0.5% povidone iodine solution. The intraoperative pathological examination confirmed the tuberculosis of the knee joint, and systemic anti-tuberculosis treatment was performed. The operation time, postoperative hospitalization stay, postoperative anti-tuberculosis chemotherapy time, and complications were recorded. CRP and ESR were recorded and compared before and after operation. Anteroposterior and lateral X-ray films of the knee joint were taken to evaluate whether the prosthesis had signs of loosening and sinking, and to determine whether there was recurrence of tuberculosis. The knee joint function was evaluated by HSS score. With treatment failure due to any reason as the end event, the survival time of prosthesis was analyzed by Kaplan-Meier survival curve.@*RESULTS@#All operations were successfully completed without fracture, vascular and nerve injury, deep vein thrombosis, and other complications. All incisions healed by first intention after operation. The operation time ranged from 80 to 135 minutes, with an average of 102.76 minutes; postoperative hospitalization stay was 5-16 days, with an average of 9.7 days; the duration of postoperative anti-tuberculosis chemotherapy ranged from 1 to 18 months, and the median duration was 12 months. All 38 cases were followed up 3-133 months (mean, 63.7 months). At last follow-up, CRP was (4.88±1.24) mg/L and ESR was (13.00±2.97) mm/1 h, both of which were significantly lower than those before operation ( t=20.647, P<0.001; t=20.886, P<0.001). During the follow-up, 3 patients (7.89%) had tuberculosis recurrence. Two patients had tuberculosis recurrence due to withdrawal of anti-tuberculosis chemotherapy at 1 and 2 months after operation, respectively. One patient was cured after debridement, preservation of prosthesis and anti-tuberculosis chemotherapy for 12 months, and 1 patient was cured after oral administration of anti-tuberculosis drugs for 12 months. Another 1 patient had recurrent tuberculosis and mixed infection ( Corynebacterium gehreni) at 2 months after operation, and the infection was not controlled after debridement, and finally the thigh was amputated. Except for the patients with recurrent infection, no complications such as prosthesis loosening, periprosthetic fracture, and periprosthetic infection were found. At last follow-up, the HSS score of the knee joint was 86.8±4.8, and the knee joint function significantly improved when compared with that before operation ( t=-31.198, P<0.001). Prosthesis survival time was (122.57±5.77) months [95% CI (111.25, 133.88) months], and the 10-year survival rate was 92.1%.@*CONCLUSION@#One-stage TKA combined with postoperative antituberculous chemotherapy in the treatment of advanced active knee tuberculosis can achieve satisfactory infection control and joint function.

A multicenter randomized controlled trial of domestic robot-assisted and conventional total knee arthroplasty / 中国修复重建外科杂志

OBJECTIVE@#To investigate the accuracy, safety, and short-term effectiveness of a domestic robot-assisted system in total knee arthroplasty (TKA) by a multicenter randomized controlled trial.@*METHODS@#Between December 2021 and February 2023, 138 patients with knee osteoarthritis who received TKA in 5 clinical centers were prospectively collected, and 134 patients met the inclusion criteria were randomly assigned to either a trial group ( n=68) or a control group ( n=66). Seven patients had lost follow-up and missing data, so they were excluded and the remaining 127 patients were included for analysis, including 66 patients in the trial group and 61 patients in the control group. There was no significant difference ( P>0.05) in gender, age, body mass index, side, duration of osteoarthritis, Kellgren-Lawrence grading, preoperative Knee Society Score (KSS) and Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score between the two groups. The trial group completed the TKA by domestic robot-assisted osteotomy according to the preoperative CT-based surgical planning. The control group was performed by traditional osteotomy plate combined with soft tissue release. Total operation time, osteotomy time of femoral/tibial side, intraoperative blood loss, and postoperative complications were recorded and compared between the two groups. The radiographs were taken at 5 and 90 days after operation, and hip-knee-ankle angle (HKA), lateral distal angle of femur (LDFA), and posterior tibial slope (PTS) were measured. The difference between the measured values of the above indexes at two time points after operation and the preoperative planning target values was calculated, and the absolute value (absolute error) was taken for comparison between the two groups. The postoperative recovery of lower limb alignment was judged and the accuracy was calculated. KSS score and WOMAC score were used to evaluate the knee joint function of patients before operation and at 90 days after operation. The improvement rates of KSS score and WOMAC score were calculated. The function, stability, and convenience of the robot-assisted system were evaluated by the surgeons.@*RESULTS@#The total operation time and femoral osteotomy time of the trial group were significantly longer than those of the control group ( P<0.05). There was no significant difference in the tibial osteotomy time and the amount of intraoperative blood loss between the two groups ( P>0.05). The incisions of both groups healed by first intention after operation, and there was no infection around the prosthesis. Nine patients in the trial group and 8 in the control group developed lower extremity vascular thrombosis, all of which were calf intermuscular venous thrombosis, and there was no significant difference in the incidence of complications ( P>0.05). All patients were followed up 90 days. There was no significant difference in KSS score and WOMAC score between the two groups at 90 days after operation ( P>0.05). There was significant difference in the improvement rate of KSS score between the two groups ( P<0.05), while there was no significant difference in the improvement rate of WOMAC score between the two groups ( P>0.05). Radiological results showed that the absolute errors of HKA and LDFA in the trial group were significantly smaller than those in the control group at 5 and 90 days after operation ( P<0.05), and the recovery accuracy of lower limb alignment was significantly higher than that in control group ( P<0.05). The absolute error of PTS in the trial group was significantly smaller than that in the control group at 5 days after operation ( P<0.05), but there was no significant difference at 90 days between the two groups ( P>0.05). The functional satisfaction rate of the robot-assisted system was 98.5% (65/66), and the satisfaction rates of stability and convenience were 100% (66/66).@*CONCLUSION@#Domestic robot-assisted TKA is a safe and effective surgical treatment for knee osteoarthritis, which can achieve favorable lower limb alignment reconstruction, precise implant of prosthesis, and satisfactory functional recovery.

Values of combined detection of indexes related to serum inflammation and platelet in diagnosis of chronic periprosthetic joint infection / 中华创伤骨科杂志

Objective:To investigate the values of combined detection of serum C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), platelet count (PC), platelet count/mean platelet volume (PC/MPV) and platelet plateletcrit (PCT) in the diagnosis of chronic periprosthetic joint infection (PJI).Methods:From January 2013 to December 2019, 441 patients underwent hip or knee joint revision at Department of Articular Surgery, The First Hospital Affiliated to Xinjiang Medical University. The patients were divided into a chronic PJI group and an aseptic prosthetic loosening group. In the chronic PJI group of 147 cases (86 hip ones and 61 knee ones), there were 64 males and 83 females, with a mean age of 66 (54, 72) years. In the aseptic prosthetic loosening group of 294 cases (210 hip ones and 84 knee ones), there were 98 males and 196 females, with a mean age of 63 (49, 72) years. The preoperative levels of CRP, ESR, PC, PC/MPV and PCT were compared between the 2 groups. The best cut-off value, sensitivity and specificity of the above indicators for the diagnosis of chronic PJI were recorded. The diagnostic efficacy of the 5 indicators in combination for chronic PJI was evaluated by comparing the area under the curve (AUC) among the indicators and analyzing the results of combined diagnostic detections.Results:Except for gender and joint revision site, there was no significant difference in the other general data between the 2 groups, showing comparability ( P>0.05). The levels of CRP, ESR, PC, PC/MPV and PCT in the PJI group were significantly higher than those in the aseptic prosthetic loosening group ( P<0.05). For CRP, ESR, PC, PC/MPV and PCT, respectively, the best cut-off values were 9.05 mg/L, 38.5 mm/h, 288×10 9/L, 29.34 and 0.33%, the sensitivities 83%, 71%, 44%, 44% and 33%, the specificities 85%, 86%, 84%, 84% and 90%, and the AUCs 0.868, 0.822, 0.688, 0.696 and 0.659. For CRP+ESR+PC+PC/MPV+PCT and CRP+PC+PC/MPV+PCT, respectively, the AUCs were 0.871 and 0.882, the sensitivities 80% and 84%, and the specificities 86% and 84%, showing significant differences in the diagnosis of chronic PJI compared with ESR, PC, PC/MPV and PCT alone ( P<0.05). Conclusion:In the diagnosis of chronic PJI, serum CRP and ESR combined with PC, PC/MPV and PCT have a reference value, but PC, PC/MPV or PCT alone only has a limited value.

Social anxiety and associated factors among graduate students under the normalization of epidemic prevention and control / 中国学校卫生

Objective@#To understand social anxiety and relevant factors among graduate students under the normalization stage of COVID-19 epidemic prevention and control.@*Methods@#Using convenience sampling method, an online questionnaire survey on graduate students from 5 universities in Jiangsu Province was conducted. Measurements used in the survey includes General Self Efficacy Scale (GSES), General Alienation Scale (GAS), Interaction Anxiousness Scale (IAS) and self made survey for basic information and household living conditions.@*Results@#The overall score of graduate students self efficacy was (2.58±0.50). Average score was (30.68±6.22) for alienation, and (47.55±8.77) for interaction anxiety, with detection rate of social anxiety being 43.96%. Increased dependence on smartphones and electronic devices ( OR=1.86, 95%CI =1.32-2.61) and high alienation score (medium level: OR=2.06, 95%CI =1.45-2.92; high level: OR=5.19, 95%CI =1.00-27.00) were positively correlated with social anxiety. Increased communication with friends ( OR=0.65, 95%CI =0.47-0.90 and high self efficacy (medium level: OR= 0.37 , 95%CI =0.21-0.66; high level: OR=0.15, 95%CI =0.08-0.30) were negatively correlated with social anxiety.@*Conclusion@#At the normalization stage of COVID-19 epidemic prevention and control, social anxiety of graduate students is one of the mental health issues which need further attention. Participation in peer support helps prevent social anxiety through developing self efficacy, alleviating individual alienation, and reducing dependence on electronic devices among graduate students.

Physical, intellectual and genetic characteristics of 53 neonates with phenylketonuria / 预防医学

Objective@#To investigate the physical and intellectual development and mutation characteristics of the phenylalanine hydroxylase (PAH) gene among 53 newborns with phenylketonuria (PKU), so as to provide insights into the management and genetic counseling of PKU@*Methods@#The medical records of 54 children with definitive diagnosis of PKU and standardized therapy until 2 years at the Center for Neonatal Disease Screening of Shanxi Children' s Hospital from 2018 to 2021 were collected. Newborns' body weight and height developments were evaluated using the World Health Organization growth chart (2006 version), and the intellectual development was assessed using the national criteria of Development Behavior Assessment Scale among Children at Ages of 0 to 6 Years (WS/T 580-2017). The gene mutations were detected among neonates and their children, and the physical, intellectual developments and genetic characteristics of neonates with PKU were descriptively analyzed.@*Results@#The 53 PKU cases included 29 male children and 24 female children, 36 cases with classic PKU and 17 cases with mild PKU, and 30 cases from rural areas and 23 cases from urban areas. The study subjects had a median age of 30 (10) d at initial therapy, and a mean blood phenylalanine concentration of (1 507±685) μmol/L at definitive diagnosis. There were 52 cases with normal height developments (98.11%), and all cases had normal weight and intellectual developments. The mean developmental functional quotient (DFQ) was significantly greater among urban children with PKU than among rural children [(94.92±8.57) vs. (87.65±6.57); t=-3.498, P=0.001], and the mean DFQ was significantly higher among children with mild PKU than among those with classic PKU [(95.55±8.76) vs. (88.57±7.11); t=-3.095, P=0.003]. There were 37 mutations detected in the PAH gene, which were mainly distributed in exons 3, 6, 7, 11, 12 and intron 4. Three high-frequency mutation sites were detected, including c.728G>A, c.611A>G and c.1197A>T, including three novel mutations (c.674C>G, c.1316-2A>C and c.1069T>C).@*Conclusions@#Following standardized treatment, the children with PKU have comparable physical and intellectual developments as compared to normal children. c.728G>A, c.611A>G and c.1197A>T were predominant mutations in the PAH gene among these 53 children with PKU, and three novel mutations were identified, including c.674C>G, c.1316-2A>C and c.1069T>C.

Changing of white blood cell count and proportion of polymorphonuclear cells of synovial fluid in total knee arthroplasty patients before and after operation / 中华骨科杂志

Objective:To investigate the changes and clinical significance of white blood cell (WBC) count and polymorphonuclear cells (PMN) proportion of synovial fluid after primary total knee arthroplasty (TKA).Methods:A total of 59 patients (92 knees) who underwent TKA from April 2021 to July 2021 were included, including 13 males (20 knees) and 46 females (72 knees). The patients were with average age 65.17±7.49 years old (range 48-79) and with body mass index (BMI) 27.64±3.74 kg/m 2 (range 17-36 kg/m 2). There were 26 cases involved lateral knee and 33 cases bilateral knees. The left knee was involved in 46 knees, while other 46 were involved in right side. There were 54 patients diagnosed as osteoarthritis (84 knees) and 5 as rheumatoid arthritis (8 knees). None of the patients received antibiotics after hospitalization. Antibiotics were used prophylactically 30 min before surgery and after surgery. The synovial fluid WBC count and PMN proportion were detected during operation (It reflects the normal preoperative level) and on the 2nd, 5th and 35th day after operation. The changes of these indexes were analyzed. The unmixed synovial fluid was collected after the incision of the joint capsule during the operation. The outer upper edge of the patella was taken as the puncture point to extract the synovial fluid on the 2nd, 5th and 35th days after the operation. The final follow-up end point was a diagnosis of acute periprothetic joint infection (PJI) or 90 days of follow-up for patients without PJI. Results:After operation, the synovial fluid WBC count and PMN proportion showed a trend of increasing and then decreasing. The synovial fluid WBC count were 0.222(0.100, 0.567)×10 9/L, 20.011(14.573, 29.129)×10 9/L, 6.080(3.676, 8.797)×10 9/L, 0.533(0.394, 0.749)×10 9/L before surgery and at 2nd, 5th and 35th day after surgery respectively. The difference before and after operation was statistically significant (χ 2=247.343, P<0.001). The synovial fluid PMN proportion were 19.9%(15.0%, 30.0%), 96.0%(95.0%, 97.0%), 91.0%(89.0%, 93.0%) and 20.5%(15.6%, 26.9%) respectively and with significant difference (χ 2=242.521, P<0.001). Pairwise comparison of synovial fluid WBC count and PMN proportion before and on day 35 indicated no statistical significance ( P>0.05). However, the differences compared with that at other time points were statistically significant ( P<0.05). Conclusion:The synovial fluid WBC count and PMN proportion increased rapidly in the short term after TKA and then decreased to the preoperative level at varied rates. Referring to the Musculoskeletal Infection Society (MSIS) recommended threshold for diagnosing infection during the acute stress period (within 5 d postoperatively) can result in false positives. Recovery to preoperative levels at 35th days postoperatively can be used as a basis for ruling out early infection. Thus, early joint fluid PMN proportion may have more diagnostic value than WBC counts.

Efficacy of Watchman occlusion of the left atrial appendage in patients ≥85 years with atrial fibrillation / 中华老年医学杂志

Objective:To analyze the safety and efficacy of left atrial appendage closure(LAAC)with Watchman in patients ≥85 years with atrial fibrillation(AF).Methods:515 elderly patients with atrial fibrillation, including 73 patients aged 85 years or older(85~91), who had undergone Watchman LAAC at Zhoupu Hospital affiliated to Shanghai Health Medical College from August 2016 to December 2020, were retrospectively analyzed.Of those ≥85 years, 44(60.3%)with transesophageal echocardiography records were assigned to the elderly group.Fifty-three patients aged 60 to 65 were selected as the control group.Differences in baseline data, intraoperative conditions, antithrombotic treatment plans and 1-year follow-up prognosis were compared between the two groups.Results:Compared with the control group, there was no difference in AF types, history of ischemic stroke/transient ischaemic attack(all P>0.05), but there were higher incidences of coronary heart disease and renal insufficiency, more severe heart failure, higher CHA 2DS 2-VASC(6.0±1.5 vs.3.6±1.5), HAS-BLED(3.2±1.2 vs.2.3±1.3)scores( t values were 7.682 and 3.871, respectively, P<0.05), and a lower one-stop surgery rate(6 cases or 13.6% vs. 27 cases or 50.9%, χ2=10.517, P<0.05)in the advanced age group.There was no difference in the diameter of the Watchman device, rate of device replacement, compression percentage and residual flow between the two groups during the perioperative period.The incidences of device-related thrombosis were 4.5%(2/44)and 3.8%(2/53)for the advanced age group and the control group, respectively, but the difference was not statistically significant( P>0.05). During the 12-month follow-up, there were no cases of ischemic stroke or intracerebral hemorrhage.Three died of heart failure and 1 died of cancer. Conclusions:LAAC with Watchman is safe and effective for patients over 85 years with AF, but the decision on the procedure should be based on careful assessment of patients' cardiac and renal function and general health.