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.

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.

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.

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.

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.

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.

Analysis of brachial-ankle pulse wave velocity in 1 607 adolescents / 中华实用儿科临床杂志

Objective:To explore the distribution characteristics of brachial-ankle pulse wave velocity (BaPWV) in adolescents.Methods:Cross sectional survey research.A total of 1 607 adolescents aged 12-17 years from 5 middle schools in the Haidian District, Beijing from June 2020 to May 2021 were enrolled for measuring their blood pressure, weight, height and the body mass index (BMI), including 782 males and 825 females.BaPWV was measured using an arteriosclerosis detector.They were divided by the age, sex and obesity.Differences of measurement data among multiple groups were compared by one-way ANOVA, followed by the LSD test, and those between groups were compared by the two-sample t-test.The correlation between BaPWV and other indexes was assessed by the Pearson correlation analysis. Results:The median level of BaPWV in adolescents aged 12-17 years increased with age, which was 982.50 cm/s in adolescents aged 12 years, and maximum 1 113.50 cm/s those aged 17 years.BaPWV in adolescents aged 12-17 years was positively correlated with age ( r=0.936, P=0.006). Subgrouped by the sex, the median BaPWV of male and female adolescents aged 12 years was 962.25 cm/s and 997.50 cm/s, respectively, which reached 1 122.50 cm/s and 1 096.00 cm/s in those aged 17 years, respectively.BaPWV of male and female adolescents was positively correlated with the age ( r=0.903, P=0.014; r=0.945, P=0.004). In male adolescents, BaPWV was positively correlated the systolic and diastolic blood pressure, age, weight, height, BMI( r=0.308, P<0.001; r=0.289, P<0.001; r=0.478, P<0.001; r=0.190, P<0.001; r=0.315, P<0.001; r=0.109, P=0.002). In female adolescents, BaPWV also was positively correlated the systolic and diastolic blood pressure, age, weight, height, BMI( r=0.340, P<0.001; r=0.285, P<0.001; r=0.379, P<0.001; r=0.115, P=0.001; r=0.170, P=0.001; r=0.097, P=0.014). In the overall population, BaPWV was statistically significant between the obese and normal groups ( t=-3.428, P=0.001). No significant difference in BaPWV between male and female adolescents aged 12-13 years was identified ( t=0.123, P=0.902 ), but it was significantly lower in female adolescents aged 14-15 years and 16-17 years than those of age-matched males( t=2.315, P=0.021; t=2.152, P=0.032). Conclusions:The median BaPWV level in adolescents aged 12-17 years, increases with the age.Systolic blood pressure, diastolic blood pressure, body weight, BMI, age and height are positively correlated with BaPWV in adolescents.Obesity can increase the stiffness of blood vessels, which is influenced by the sex.

rotective effect of bone marrow mesenchymal stem cells-derived exosomes against testicular ischemia-reperfusion injury in rats / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the protective effect of bone marrow mesenchymal stem cells (BMSCs)-derived exosomesagainst testicular ischemia-reperfusion injury (IRI) in rats.</p><p><b>METHODS</b>Rat BMSCs were isolated, cultured and identified in theprimary culture. The exosomes were extracted from the BMSCs and characterized using nanoparticle tracking analysis, transmission electron microscopy, and Western blotting. Twenty-four healthy male SD rats were randomly divided into shamoperation group, testicular IRI with saline treatment group and IRI with exosome treatment group. The contralateral testes ofthe rats were collected for pathological observation, aseessment of superoxide dismutase (SOD) and malondialdehyde (MDA), and detection of HMGB1, caspases-3 and cleaved caspase-3 expressions using Western blotting.</p><p><b>RESULTS</b>We successfullyobtained exosomes from rat BMSCs. Testicular IRI significantly impaired testicular spermatogenesis, which was markedlyimproved by treatment with the exosomes ( < 0.05). Testicular IRI also caused significant increase in the protein expression ofHMGB1, caspase-3 and cleaved caspase-3 in the testicular tissue, and treatment with the exosomes obviously amelioratedthese changes ( < 0.05).</p><p><b>CONCLUSIONS</b>BMSCs-derived exosomes protects against testicular IRI due to the anti-oxidant, antiinflammatory and anti-apoptosis activities of the exosomes.</p>

A case-control study of cognitive impairment and related factors among elderly patients / 中国心理卫生杂志

Objective: To explore risk factors for cognitive impairment among elderly patients. Methods: There were 257 qualified subjects recruited, a case-control study was performed by collecting data of Mini Mental State Examination, carotid artery color Doppler flow imaging, biochemical tests, personal information on ages, medical histories, smoking as well as physical exercise among the recruited elderly in-patients/out-patients. A logistic regression was conducted to screen main effects of variables on occurrences of cognitive impairment. Results: Using logistic regression, the carotid intima-media thickness was found to be a significant risk factor (P<0.001) with larger regression coefficients (15.105 - 22.065) for the occurrence of cognitive impairment among elderly; about 71％ -78％ and 4％ decrease in risks of dementia occurrence for every 1 pg/mL serum free triiodothyronine and lkg body weight increase. Conclusion: The increase in carotid intima-media thickness is a significant risk factor for the occurrence of cognitive impairment among elderly patients. The decrease in serum free triiodothyronine and body weight are the related factors to increase risk for dementia.

Survey on activities of daily living and analysis of the influencing factors among elder hospitalization patients / 中华老年医学杂志

Objectives To investigate the activities of daily living and analysis of the influencing factors among elder hospitalization patients.Methods A series of scales including Activity of Daily Living Scale,Mini-Nutritional Assessment,Mini Mental State Examination,Geriatric Depression Scale 15,Falls Risk Assessment Tool and Euro Qol-5D Questionnaire were used to assess the physical and psychological health status among elder patients at first hospitalization,as well as their social-economic status,and to analyze the activities of daily living and influencing factors.Results Interviewees with less than nine years educational level had 5.93 (95 ％ CI:1.14-33.23)times higher risk for impaired activities of daily living than those with higher education levels.Patients with EQ-5D score ≥1 scale or with cognitive disorder showed 2.86 (95％ CI:1.04-8.05) times or 18.14 (95 ％ CI:1.64-540.63) times higher risks for impaired activities of daily living than their normal controls,respectively.The risks for the decreasing activities of daily living were increased along with ageing (P =0.025).There was a marginal correlation between regular exercise and activities of daily living(P=0.104).Conclusions Educational level,health status and cognitive function are important factors for activities of daily living among elder hospitalization cases and enlarged sample size is required for validation.

Study on experimental autoimmune encephalomyelitis with oxymatrine on rats model / 中国生化药物杂志

Objective To establish experimental autoimmune cerebral spinal cord inflammation ( EAE) model rats, and observe the pathological changes and effect of oxymatrine on EAE model.Methods 30 rats were randomly divided into control group,EAE ( model group) group and oxymatrine group.The EAE symptom score was used to evaluate the rats after the model, and to observe the changes of its behavior.By HE staining and Kluver &Barrera myelin dyeing to observe the inflammation of the brain and spinal cord demyelinating changes.Results The animals in control group had no change in behavior and pathological.In model group, all animals occured behavioral changes, accompanied by varying degrees of demyelination and inflammatory infiltration of the brain and spinal cord.In oxymatrine group,6 rats did not appear EAE clinical manifestations and behavioral change, and the myelin structure was intact.Conclusion Oxymatrine can extend the incubation period experimental autoimmune encephalomyelitis in rats of the disease, relieve symptoms and protect nerve.