Debridement, antibiotics irrigation and implant retention for acute periprosthetic joint infection after primary total joint arthroplasty / 中华创伤骨科杂志

Objective:To analyze the clinical efficacy of debridement, antibiotics irrigation and implant retention (DAIR) in the treatment of acute periprosthetic infection (PJI) and to explore the risk factors leading to the failure of DAIR.Methods:From January 2010 to January 2021, 122 patients underwent DAIR for acute PJI at Department of Orthopedics, General Hospital of Eastern Theater of PLA. They were 55 males and 67 females, aged from 50 to 86 years (mean, 68.0 years). Their C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), body temperature, white blood cell count and visual analogue scale (VAS) were compared at admission and discharge to analyze the clinical efficacy of DAIR. The 122 patients were assigned into a cured group (81 cases) and an uncured group (41 cases). Risk factors were screened by univariate analysis out of their gender, age, body mass index, site of infection, type of infection (early postoperative infection or acute hematogenous infection), type of surgery (primary or revision), comorbidities, CRP, ESR, albumin and hemoglobin at admission, duration of symptoms, Staphylococcus aureus infection, multiple bacterial mixed infection, and preoperative sinus tract. For the factors of P<0.05, multivariate binary logistic regression analysis was used to determine the risk factors for failure of DAIR. Survival curves were plotted for the patients using DAIR failure as the endpoint event. Results:The CRP, ESR, VAS score, body temperature and white blood cell count at discharge in the 122 patients were significantly lower than the corresponding values at admission ( P<0.05). The success rate of DAIR was 66.39%(81/122). The multivariate binary logistic regression analysis suggested that duration of symptoms over 3 weeks( OR=1.230, 95% CI: 1.092~1.576, P=0.020), Staphylococcus aureus infection( OR=4.607, 95% CI: 2.057~10.318, P<0.001), preoperative sinus tract( OR=6.115, 95% CI: 2.630~14.220, P<0.001) and multiple bacterial mixed infection( OR=2.600, 95% CI: 1.131~5.977, P=0.020) were risk factors for DAIR failure; Kaplan-Meier survival curve also confirmed that the patients with Staphylococcus infection, multiple bacterial mixed infection, duration of symptoms over 3 weeks, or preoperative sinus tract had a significantly lower rate of survival than their controls ( P<0.05). Conclusions:For acute PJI, DAIR can be used to retain the prosthesis and control infection. However, DAIR is not recommended for the patients with Staphylococcus aureus infection, multiple bacterial mixed infection, symptoms lasting more than 3 weeks, or preoperative sinus formation.

Long non-coding RNA DANCR enhances chondrogenic differentiation and proliferation of human synovium-derived mesenchymal stem cells / 中国组织工程研究

BACKGROUND: A number of studies have shown that long non-coding RNA DANCR can play an important role in various pathophysiological processes through Wnt/β-catenin signaling pathway.OBJECTIVE: To explore the effect of long non-coding RNA DANCR on the proliferation and chondrogenesis of synovium-derived mesenchymal stem cells.METHODS: Passage 3 synovium-derived mesenchymal stem cells were obtained and transfected with pcDNA3.1-GP (control) and pcDNA3.1-GP(DANCR Homo) (experimental). Cell viability was estimated at 1, 2, 3, 4, 5, 6 and 7 days after DANCR transfection. The passage 3 cells were cultured in the chondriogenic medium for 14 days. And the chondrogenesis potential of cells was examined by toluidine blue staining. The chondrogenic-specific marker genes Aggrecan, Type II collagen (Col2) and Sox9 were determined by Real-time PCR.RESULTS AND CONCLUSION: The synovium-derived mesenchymal stem cells exhibited S-shaped curves in the two groups, with cell arrest at 1-2 days and rapid proliferation beginning at 3 days. Cell counting kit-8 assay and toluidine blue staining showed overexpressing DANCR significantly promoted proliferation in synovium-derived mesenchymal stem cells. The aggregates from synovium-derived mesenchymal stem cells in the experimental group had a greater amount of toluidine blue staining than the control group. In addition, we detected the higher expression of chondrogenic specific marker genes, such as Col2, Sox9 and Aggrecan, in the experimental group than the control group at 14 days after chondrogenic induction (P < 0.05). These results demonstrate that long non-coding RNA DANCR could enhance chondrogenic differentiation and proliferation of human synovium-derived mesenchymal stem cells and increase the expression of chondrogenic specific marker genes.

Review on long non-coding RNA DANCR enhances chondrogenic differentiation and proliferation of human synovium-derived mesenchymal stem cell / 医学研究生学报

Long non-coding RNA( LncRNA) is an RNA molecule that is longer than 200 nucleotides and is not translated into a protein.LncRNA DANCR has been identified in hepatocellular carcinoma ( HCC) and markedly increased stemness features of HCC cells to promote tumorigenesis.Recent studies show that DANCR contributes to the differentiation and proliferation of synovium-derived mesenchymal stem cell ( SMSCs) and may be as a key point for this process.This article reviews the role of long non-coding RNA DANCR in enhancing chondrogenic differentiation and proliferation of human SMSCs.

Regulation of osteoarthritis hypoxia-inducible factor-2alpharegulatory mechanism and application prospect / 中国组织工程研究

BACKGROUND:Hypoxia inducible factor-2 α(HIF-2α)is one of the key regulators in articular cartilage degeneration and endochondral osteogenesis. OBJECTIVE:To review the regulatory mechanism and application development of HIF-2α in articular cartilage degeneration. METHODS:A computer-based retrieval of PubMed and CNKI databases was performedforrelevant literatures published from January 1990 to October 2015 ,using the key words of “hypoxia inducible factor-2α; osteoarthritis; cartilage” in Chinese and English, respectively. RESULTS AND CONCLUSION:HIF-2α is a transcription factor encoded by the Epas1 gene, which is one of the key regulators in articular cartilage degeneration and endochondral osteogenesis by directly regulating the expressions of various catabolic genes to strengthen cartilage destruction in osteoarthritis. It has been reported that HIF-2α acts on the chondrocytes by regulating the expressions of Wnt/β-Catenin, nuclear factor-κ B, and interleukin-6.

Diagnosis and treatment of medial plica syndrome of the knee by arthroscopy:Analysis of 46 cases / 医学研究生学报

Objective With the emerging omnipresence of arthroscopy, the plica syndrome has achieved a clinical recogni-tion as a pathological entity .This study is to investigate the clinical diagnosis and treatment of the medial plica syndrome of the knee . Methods We retrospectively analyzed 198 cases of medial plica syndrome, internal semilunar cartilage and chondromalacia patellae in the knee joints treated in our department from January 2008 to December 2011 .All the patients received physical and MRI examina-tions before admission and underwent plicaectomy, their knee function evaluated according to their Lysholm scores pre-and post-opera-tively. Results The diseased plica synovialis was completely excised in 46 cases diagnosed as simple medial plica syndrome by ar-throscopy.Forty-four of the patients were followed up for 6 to 32 (mean 26) months, and the excellence rate of treatment result was 95.5%. Conclusion Medial plica syndrome of the knee constitutes a larger proportion of knee disorders, for which arthroscopy re-mains the best diagnostic option and total excision of the diseased plica synovialis is an effective treatment .

Semaphorins play an important role in bone homeostasis and metabolic bone disease / 中国组织工程研究

BACKGROUND:Bone formation is a dynamic process, and osteoclasts and osteoblasts are involved in this dynamic process. Semaphorins were found first as axonal growth cone guidance molecules, which express in many different tissues and regulate many physiological processes. Recently, Semaphorins are confirmed to play an important role in the regulation of osteoclasts and osteoblasts. OBJECTIVE:To summarize the role of Semaphorins in bone homeostasis. METHODS: A computer-based search of PubMed and Web of Science was performed for articles related to the effect of Semaphorins in regulation of bone metabolism published from June 1993 to January 2014 using the keywords of “semaphorin, sema”. Irrelevant articles or duplicate content articles were excluded, and finaly 48 articles were reviewed. RESULTS AND CONCLUSION:Semaphorins act as a new class of regulatory molecules in the aspect of bone cytobiology. Studies have show semaphorins are actively involved in bone remodeling through some special mechanisms, and semaphorin proteins are crucial for bone homeostasis, which provides a new method and therapeutic target for the treatment of osteoporosis, bone sclerosis, osteolysis adjacent to joint prosthesis and other bone diseases.

Clinicopathologic characteristics and surgical treatment of obsolete Bennett fractures / 中华创伤骨科杂志

Objective To investigate clinicopathologic characteristics of obsolete Bennett fractures and their surgical treatment and prognosis. Methods From August 2008 to April 2010,13 patients with obsolete Bennett fracture were admitted to our department.They were 12 men and one woman,with an average age of 34.3 years (from 17 to 42 years).They had a fracture history of over 4 weeks to as long as 12 weeks (average,7.9 weeks).In all patients,after X-ray examinations,the radio-dorsal ligament complex of the first carpometacarpal joint was properly released,fracture gaps were cleared up,fracture fragments were anatomically reduced and fixed with a Kirschner wire,and at last the first metacarpal joint was fixed with the Kirschner wire crossing the joint Postoperatively all patients were immobilized with cast plaster for 4 weeks before the Kirschner wires acrross the joint were removed.Gradual rehabilitation was conducted.The X-rays were taken every month. Results The patients were followed for 6 to 24 months(average,14 months).The fractures healed in all the patients,with an average healing time of 3 months.No dislocation of the joints occurred.Injury to articular cartilage of the trapezium bone occurred in one patient,and no apparent pain was experienced in the other 12 patients.According to the Total Active Motion assessment,the thumb function was rated as excellent in 9 cases,good in 2,moderate in one and poor in one,with a good to excellent rate of 84.6％.Conclusions In obsolete Bennett fractures,the radio-dorsal ligament complex of the first carpometacarpal joint will have cicatricial contracture,preventing reduction of the fragments of the radio-dorsal joint.Therefore it is important to properly release the radio-dorsal ligament complex to achieve anatomical reduction of the radio-dorsal joint.An injury history of over 3 months and complicated injury to the trapezium bone cartilage may be significant factors affecting the prognosis of obsolete Bennett factures.

Clinical Observation on Treatment of Facial Paralysis by Mild Moxibustion / 针灸推拿医学（英文版）

Objective: To observe the clinical effect of mild moxibustion for facial paralysis.Methods: One hundred cases of facial paralysis were divided randomly into two groups: 50 cases in the treatment group were treated by mild moxibustion, and 50 cases in the control group were treated by oral administration of Cobamamide Tablets. With ten days as one course of the treatments, two courses of the treatments were given. The therapeutic effects were assessed four weeks after treatments. Results: The total effective rate was 96.0% in the treatment group and 88.0% in the control group, and there was statistical difference in the therapeutic effects between the two groups (P<0.05). Conclusion: The therapeutic effect of mild moxibustion for facial paralysis is better than oral administration of Cobamamide Tablets.

A novel nanometer non-viral gene transfer system for cartilage defects / 中华创伤杂志

Objective To develop a clinically applicable approach to enhance repair of cartilage defects by constructing an in vivo non-viral gene transfer system targeting chondrocytes. Methods High molecular weight chitosan (HMWC) was degraded to produce low molecular weight chitosan (LM-WC) that was combined with transforming growth factor-β1 (TGF-β1) plasmid to form stable nano-sizc complexes. After being tested in vitro firstly, these nano-size complexes were injected into the knee joint of New Zealand white rabbit models with full-thickness cartilage defects to detect their feasibility of delive-ring the growth factor gent in vivo. Results The results showed that LMWC/DNA nano-sizc comple-xes could deliver the gone into the cultured chondroeytes and cartilage tissue efficiently in vitro. When used in vivo, LMWC/TGF-β1 gene nano-size complexes could enhance the transfection efficiency and prolong the expression of TGF-β1 gone. In the animal models of articular osteechondral defect of rabbits, better healing and gentler degeneration could be observed in comparison with the control. Conclusion In vivo transfection of LMWC/TGF-β1 nano-size complexe is a safe and effective method to early promote the repair of osteochondral defects.

Inhibitory effect of zoledronic acid on osteolysis induced by human periprosthetic tissue:an animal study / 中国矫形外科杂志

[Objective]To investigate the inhibitory effect of zoledronic acid(ZA) on osteolysis induced by human periprosthetic tissue in a novel animal model.[Method]Human periprosthetic tissue that was harvested from a patient receiving total hip revision was grafted on the calvaria bone of SCID beige mice. ZA was injected directly beneath the scalp of mice once,2 days post surgery. The mice were sacrificed 2 or 4 weeks after transplantation and the calvaria with grafted human tissue was collected for further detection.[Result]The grafted tissues were found survive for at least 4 weeks in the animals. Bone collagen collapse of the calvaria caused by periprosthetic tissue was demonstrated by HE staining. Significantly higher level of TNF-?,IL-6,RANKL and CPK both in gene expression and protein release were detected in PT grafted group,as compared with the control. Once administration of ZA remarkably reduced the expression of RANKL and CPK in both gene and protein level without affecting TNF-? and IL-6.[Conclusion]Once and local injection of ZA effectively inhibits the osteolysis induced by human periprosthetic tissue with a long lasting effect. The novel animal model could serve for evaluating the pharmaceutical effect on periprosthetic osteolysis.

Revision total hip arthroplasty using acetabular reinforcement device with grafting for the massive bone defects / 中国矫形外科杂志

[Objective]To introduce the technology of bone grafting with acetabular reinforcement device for the massive bone defects in the revision total hip arthroplasty.[Method]The massive acetabular bone defects were reconstructed in 8 cases from 2002 and 2007.The defects were classified according to the system of D'Antonio,ⅡB defects in 1 case,ⅡC defects in 2 cases,and Ⅲ defects in 5 cases.Methods:the reinforcement device with the morsellised impaction bone grafting in 3 cases,the reinforcement device with the morsellised impaction bone grafting and the structural autograft in 5 cases.Clinical and radiological evaluations were conducted for each patient.[Result]The follow-up duration averaged to 2.7 years,the Harris score were inoreased by 35 points in average.No hip required further revision of the acetabular component because of aseptic loosening.[Conclusion]The cavitary bone loss could be reconstructed by the bone-impaction grafting;the segmental bone loss could be reconstructed by the structural autograft.The acetabular reinforcement device can fix the grafted bone and support the cup.The massive periacetabular bone loss could be effectively reconstructed by reinforcement device with bone grafting.

Total hip arthroplasty for severe congenital dislocation of adult hip mellitus / 中国矫形外科杂志

[Objective]To discuss the methods and results of total hip arthroplasty for the adult hip of severe congenital dislocation.[Method]Thirteen patients with unilateral Crowe type-Ⅳ dislocation underwent total hip replacement.All patients were distracted for two weeks preoperatively,and in the operation procedure,the acetabulat rotation center and abductor function were reconstructed on the basis of soft tissue release.The evaluations after surgery included the leg-length and Harris scores.[Result]According to the follow-up with an average of 18 months,the Harris hip score averaged 90 points.The leg-length extended 3.1 cm on average.One patient appeared sciatic nerve palsy.[Conclusion]Total hip arthroplasty could effectively treat server congenital dislocation of adult hip by the methods of tissue release,reconstruction of acetabular,proper selection of prosthetic and protection of nerve.