Phosphaturic mesenchymal tumor-induced bilateral osteomalacia femoral neck fractures: a case report.

Phosphaturic mesenchymal tumors (PMT) are rare and distinctive tumors that typically result in paraneoplastic syndrome known as tumor-induced osteomalacia (TIO). We report a case of bilateral osteoporotic femoral neck fracture caused by PMT. PMT was surgically resected, followed by sequential treatment of bilateral femoral neck fractures with total hip arthroplasty (THA). A 49-year-old perimenopausal woman experienced consistent bone pain with limb weakness persisting for over 2 years. Initially, she was diagnosed with early osteonecrosis of the femoral head and received nonsurgical treatment. However, from 2020 to 2022, her pain extended to the bilateral shoulders and knees with increased intensity. She had no positive family history or any other genetic diseases, and her menstrual cycles were regular. Physical examination revealed tenderness at the midpoints of the bilateral groin and restricted bilateral hip range of motion, with grade 3/5 muscle strength in both lower extremities. Laboratory findings revealed moderate anemia (hemoglobin 66 g/L), leukopenia (2.70 × 109/L), neutropenia (1.28 × 109/L), hypophosphatemia (0.36 mmol/L), high alkaline phosphatase activity (308.00 U/L), and normal serum calcium (2.22 mmol/L). After surgery, additional examinations were performed to explore the cause of hypophosphatemic osteomalacia. After definitive diagnosis, the patient underwent tumor resection via T11 laminectomy on August 6, 2022. Six months after the second THA, the patient regained normal gait with satisfactory hip movement function without recurrence of PMT-associated osteomalacia or prosthesis loosening. By providing detailed clinical data and a diagnostic and treatment approach, we aimed to improve the clinical understanding of femoral neck fractures caused by TIO.

Research on exoskeleton compliance control strategy based on dual interaction torque split phase control method.

BACKGROUND: Human gait pattern recognition and compliance control are key technologies for achieving high coordination and assistance between exoskeleton robots and human movements. OBJECTIVE: In order to improve the adaptability of exoskeleton robots to the human body, this paper proposes an exoskeleton compliance control strategy based on dual interaction torque phase separation control method. METHODS: A support phase swing phase split control strategy based on dual interaction torque is proposed. Utilize the interaction force of human joints and adopt a model-based method to control the support phase. By utilizing the interaction force of exoskeleton joints and using a torque closed-loop method to control the swing phase, a multi-state control method of motion is achieved. RESULTS: A lower limb exoskeleton knee joint testing platform is built to verify the proposed human gait recognition The effectiveness of human-machine interaction force identification and human-machine coupling system compliance control technology. CONCLUSION: The proposed control method can effectively adjust joint torque, enabling the exoskeleton robot to maintain balance and stability during the entire walking phase.

Significance of serum protein electrophoresis in the diagnosis of Tsukayama type IV periprosthetic joint infection.

Objectives: To investigate the efficacy of serum protein electrophoresis (SPE) in the diagnosis of periprosthetic joint infection (PJI) after hip and knee arthroplasty. Methods: The medical records of patients undergoing hip and knee arthroplasty at a class A tertiary hospital between August 2013 and January 2021 were retrospectively investigated. A total of 179 patients were included and divided into two groups: 66 patients in the PJI group and 113 patients in the aseptic loosening (AL) group. Serum C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), D-dimer, Fibrinogen, Serum albumin and the proportion of serum protein in SPE were compared between the two groups. The diagnostic sensitivity and specificity were determined using the receiver operating characteristic (ROC) curve, and the diagnostic value was compared using the area under the ROC curve (AUC). Results: There was no significant difference in age, sex and body mass index (BMI) between PJI group and AL group (P>0.05), but there was significant difference in the ratio of hip to knee (X2 = 22.043, P<0.001). The CRP, ESR, D-dimer, Fibrinogen and the proportion of α1 globulin band in PJI group was 22.99(10.55,40.58) mg/L, 37.00(23.00,61.70) mm/h, 790.00(500.00,1500.00) ng/ml, 4.84(3.81,5.55) g/L and 5.80(5.00,7.73) % which was higher than that in AL group [1.89(0.50,4.12) mg/L, U=7.984, P<0.001; 10.10(7.00,16.90) mm/h, U=8.095, P<0.001; 570.00(372.50,780.00) ng/ml, U=3.448, P<0.001; 2.84(2.45,3.43) g/L, U=8.053, P<0.001 and 4.20(3.90,4.80) %, U=8.154, P<0.001]. The Serum albumin and the proportion of Albumin band in PJI group was 36.10(33.10,39.00) g/L and 49.00(44.95,52.20) % which was lower than that in AL group [38.10(34.00,41.10) g/L, U=-2.383, P=0.017 and 54.40(51.55,56.70) %, U=-6.162, P<0.001]. The proportion of In PJI group, the AUC of proportion of α1 globulin was 0.8654, which was equivalent to CRP (0.8698), ESR (0.8680) and outperformed that of fibrinogen (0.8025). Conclusions: Elevated proportion of α1 globulin in SPE presented with good diagnostic value for Tsukayama type IV PJI, and its accuracy was comparable to those of ESR and CRP. And α1 globulin can assist with CRP and ESR to determining the timing of second-stage revision.

AudioGest: Gesture-based Interaction for Virtual Reality using Audio Devices.

Current virtual reality (VR) system takes gesture interaction based on camera, handle and touch screen as one of the mainstream interaction methods, which can provide accurate gesture input for it. However, limited by application forms and the volume of devices, these methods cannot extend the interaction area to such surfaces as walls and tables. To address the above challenge, we propose AudioGest, a portable, plug-and-play system that detects the audio signal generated by finger tapping and sliding on the surface through a set of microphone devices without extensive calibration. First, an audio synthesis-recognition pipeline based on micro-contact dynamics simulation is constructed to generate modal audio synthesis from different materials and physical properties. Then the accuracy and effectiveness of the synthetic audio are verified by mixing the synthetic audio with real audio proportionally as the training sets. Finally, a series of desktop office applications are developed to demonstrate the application potential of AudioGest's scalability and versatility in VR scenarios.

The chemical damage of sandstone after sulfuric acid-rock reactions with different duration times and its influence on the impact mechanical behaviour.

The low-permeability characteristic of sandstone-type uranium deposits has become the key geological bottleneck during the in-situ leaching mining, seriously restricting the development and utilization of uranium resources in China. At present, the blasting-enhanced permeability (BEP) and acidizing-enhanced permeability (AEP) are confirmed to be mainstream approaches to enhance the reservoir permeability of low-permeability sandstone-type uranium deposit (LPSUD). To clarify the synergistic effect of BEP and AEP, the acid-rock reaction and dynamic impact experiments were conducted, aiming to study the effect of chemical reactions on pore structure, dynamic mechanical properties and failure pattern of sandstone. Results show that with the increasing acid-rock reaction time, the total pore volume of samples is promoted largely and exhibits obvious chemical damage. The change of pore volume depends on the pore size, the 100-1000 nm and 1000-10000 nm pores are more susceptible to acid-rock reactions. The dynamic peak strength and the dynamic elastic modulus are decreased and the dynamic peak strain and strain rate are increased when lengthening the acid-rock reaction time, whose evolution laws can be fitted by the logistic expression, the linear expression and the exponential expression, respectively. The acid-rock reactions also have an influence on the fracture development of samples after the dynamic impact. The damaged fractures on the end faces of samples grow from the isolated short fracture, the isolated long fracture to the fracture network, and the damaged fractures on the sides of samples develop from the non-penetration fractures, penetration fractures to the multi-branch fractures. This study clarifies the physical and chemical combined damage mechanism, demonstrates the potential of reservoir stimulation by uniting the BEP and the AEP, and provides a theoretical reference for the reservoir stimulation of LPSUD.

Intraarticular vancomycin decreased the risk of acute postoperative periprosthetic joint infection without increasing complication in primary total joint arthroplasty-a prospective study.

OBJECTIVES: To investigate the preventive effect of intraarticularly administered vancomycin on acute postoperative periprosthetic joint infection (PJI) in total joint arthroplasty (TJA). METHODS: Consecutive patients who underwent unilateral primary TJA were prospectively enrolled. The patients were divided into vancomycin group and control group according to whether 1 g of vancomycin powder suspended in 30 ml normal saline was intraarticularly administered after arthrotomy closure. Acute postoperative PJI and aseptic wound complication were evaluated within 3 months postoperatively. Vancomycin-associated toxicity including acute renal failure, ototoxicity and anaphylaxis was also evaluated. RESULTS: In terms of demographic parameters and comorbidities, no significant difference was found between the two groups. Intra-articular vancomycin significantly lowered the risk of acute postoperative PJI after primary TJA (P = 0.015) and primary total knee arthroplasty (P = 0.031). However, for patients who underwent total hip arthroplasty, the PJI rate was comparable between the two groups. Overall, the risk of aseptic wound complication between the two groups was also similar. Vancomycin-associated acute renal injury, ototoxicity, or anaphylaxis was not observed. CONCLUSIONS: Intra-articular injection of 1 g of vancomycin suspension after arthrotomy closure during TJA lowered the risk of acute postoperative PJI without increasing the risk of aseptic wound complication and vancomycin-associated systemic toxicity.

Meta-analysis of the effects of denosumab and romosozumab on bone mineral density and turnover markers in patients with osteoporosis.

Purpose: To assess the alterations in bone mineral density and bone turnover marker concentrations following the administration of denosumab and romosozumab therapies in patients with osteoporosis. Methods: PubMed was searched for studies published until January 28, 2023, that investigated the clinical efficacy and bone turnover marker changes of denosumab and romosozumab in the treatment of osteoporosis, with a minimum follow-up of 3 months in each study. Studies were screened, and data on changes in bone mineral density (BMD), P1NP, and TRACP-5b levels after treatment were extracted and included in the analysis. Results: Six studies were analyzed. At 3 months after treatment, the romosozumab group showed greater changes in lumbar BMD and bone turnover markers. BMD of total hip and femoral neck was relatively delayed. Beginning at 6 to 12 months, romosozumab showed greater changes in bone mineral density and markers of bone turnover. Conclusion: Both romosozumab and denosumab have antiosteoporotic effects, with greater effects on BMD and bone turnover markers observed within 12 months of romosozumab treatment. Systematic Review Registration: https://www.crd.york.ac.uk/prospero, identifier CRD42023395034.

Fabrication of Hydrophobic Poly(vinylidene fluoride) Membranes with Manipulated Micromorphology and Enhanced Strength.

In this work, an ethanol/water/glycerol ternary coagulation bath system was used to fabricate a hydrophobic PVDF membrane, which will have a considerable impact on the micromorphology. This change will further affect the performance of the membrane. After introducing glycerol into the coagulation bath, the precipitation process was finely regulated. The obtained results implied that glycerol could inhibit solid-liquid separation and promoted liquid-liquid separation. A pleasant discovery was that the mechanical properties of the membrane were improved because of the more fibrous polymers formed by liquid-liquid separation. Besides, a more uniform pore size can be achieved. A fascinating symmetrical interconnected fibrous and spherulitic structure was depicted by membranes fabricated with a coagulation bath consisting of 6% water, 34% ethanol, and 60% glycerol. This membrane had a high water contact angle of 146.6° and a small mean pore size of 0.46 µm. Enhanced tensile strength and elongation at break evidenced that the membrane enjoyed good robustness and flexibility. This facile approach provided the possibility to prepare membranes with tailored pore size and the required strength.

Vancomycin presoak reduces infection in anterior cruciate ligament reconstruction: a systematic review and meta-analysis.

PURPOSE: To compare the effect of vancomycin presoak treatment of grafts during anterior cruciate ligament reconstruction on the incidence of postoperative infection or septic arthritis. METHODS: Studies published before May 3, 2022 investigating vancomycin presoak of grafts during anterior cruciate ligament reconstruction were searched in the PubMed and Cochrane Central Register of Controlled Trials. Studies were screened, and data on the incidence of postoperative infection or septic arthritis were extracted and included in the analysis. RESULTS: Thirteen studies were included for analysis after search screening, yielding a total of 31,150 participants for analysis, of whom 11,437 received graft vancomycin presoak treatment, and 19,713 did not receive treatment. Participants who received vancomycin treatment had significantly lower infection rates (0.09% versus 0.74%; OR 0.17; 95% CI 0.10, 0.30; P < 0.00001). CONCLUSION: Pre-soaking of the graft with vancomycin during ACL reconstruction reduced the incidence of postoperative infection and septic arthritis.

Equivalence of clinical and radiological outcomes in cruciate-retaining and cruciate-substituting total knee arthroplasty with medial pivot knee: A comparative study.

Introduction: Total knee arthroplasty (TKA) has been recognized as the most efficacious surgical intervention for individuals suffering from advanced arthritis; however, there is ongoing debate on the technical details of the procedure. It remains unknown whether preservation of the posterior cruciate ligament (PCL) significantly affects the mid-to long-term performance of ADVANCE® medial-pivotal (AMP) knee implants to enhance patient satisfaction. The hypothesis of this study was to investigate whether the preservation of the PCL has a substantial impact on the functional outcomes of medial pivot (MP) implants in patients undergoing TKA. Therefore, this study aimed to compare the midterm clinical and radiographic outcomes of cruciate-retaining (CR) and cruciate-substituting (CS) TKA using MP prostheses. Methods: We included 376 consecutive patients who underwent unilateral TKA between January 2011 and April 2014. Follow-up evaluations were conducted in April 2021. After propensity score matching analysis, clinical and radiological outcomes and complication rates were compared between patients in the CR and CS groups. Results: The postoperative outcomes in the two groups significantly improved the preoperative conditions of the patients (all p > 0.05). The postoperative outcomes (WOMAC score, p = 0.517; KSS, p = 0.107; KSFS, p = 0.240; ROM, p = 0.795; FJS, p = 0.822) and radiographic outcomes (preoperative FTA, p = 0.997; postoperative FTA, p = 0.646; aLDFA, p = 0.094; aMPTA, p = 0.970; PTS, p = 0.243) were comparable between the two groups. The complication and revision rates between the groups were not statistically significant (p = 0.34). The Kaplan-Meier cumulative survival of patients in the CRTKA and CSTKA groups was 100 % and 98.6 %, respectively. Conclusions: This study supports the hypothesis that when MP prostheses are used, both CR and CS procedures achieve equally good mid-to long-term clinical and radiographic outcomes and complication rates. These findings suggest that PCL preservation may not significantly affect the overall performance of MP implants in patients undergoing TKA.

WDR43 is a potential diagnostic biomarker and therapeutic target for osteoarthritis complicated with Parkinson's disease.

Osteoarthritis (OA) and Parkinson's disease (PD) are on the rise and greatly impact the quality of individuals' lives. Although accumulating evidence indicates a relationship between OA and PD, the particular interactions connecting the two diseases have not been thoroughly examined. Therefore, this study explored the association through genetic characterization and functional enrichment. Four datasets (GSE55235, GSE12021, GSE7621, and GSE42966) were chosen for assessment and validation from the Gene Expression Omnibus (GEO) database. Weighted Gene Co-Expression Network Analysis (WGCNA) was implemented to determine the most relevant genes for clinical features. Then, Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) were carried out to explore the biological processes of common genes, and to display the interrelationships between common genes, the STRING database and the application Molecular Complex Detection Algorithm (MCODE) of Cytoscape software were leveraged to get hub genes. By intersecting the common genes with the differentially expressed genes (DEGs) acquired from GSE12021 and GSE42966, the hub genes were identified. Finally, we validated the diagnostic efficacy of hub genes and explored their correlation with 22 immune infiltrating cells. As a consequence, we discovered 71 common genes, most of which were functionally enriched in antigen processing and presentation, mitochondrial translation, the mRNA surveillance pathway, and nucleocytoplasmic transport. Furthermore, WDR43 was found by intersecting eight hub genes with 28 DEGs from the two validation datasets. Receiver Operating Characteristic (ROC) implied the diagnostic role of WDR43 in OA and PD. Immune infiltration research revealed that T-cell regulatory (Tregs), monocytes, and mast cells resting were associated with the pathogenesis of OA and PD. WDR43 may provide key insights into the relationship between OA and PD.

The correlation of temporal changes of neutrophil-lymphocyte ratio with seizure severity and the following seizure tendency in patients with epilepsy.

Background: Changes in the neutrophil-lymphocyte ratio (NLR) has been reported to be associated with epilepsy. Here we aim to investigate the correlation of temporal changes of NLR level with seizure severity and the follow-up seizure attacks in patients with epilepsy (PWE). Methods: We performed a retrospective analysis of the laboratory data including leukocyte count and NLR within 24 h of acute seizure and during the follow-up period of 5-14 days after acute seizure (NLR1, NLR2, respectively) in 115 PWE, and 98 healthy individuals were included as controls in this study. The correlation of laboratory data with seizure types, etiology of epilepsy, anti-seizure drugs (ASDs), seizure severity, and the follow-up seizure attacks in PWE was studied. Results: Leukocyte count (P < 0.001) and NLR level (P < 0.001) were found significantly different between PWE and controls. On the other hand, a multivariable logistic regression analysis showed that NLR1 level (OR = 2.992, P = 0.001) and admission leukocyte (OR = 2.307, P = 0.002) were both independently associated with acute epileptic seizures. Especially, higher NLR1 level was significantly associated with status epileptics (P = 0.013) and recurrent seizures after admission (P < 0.001). Furthermore, the multivariable logistic regression analysis indicated that higher NLR1 was a predictor for the tendency of the following recurrent seizure attacks (OR = 1.144, P = 0.002). NLR2 was inversely correlated with ASDs taken (P = 0.011). Levels of NLR1 (r = 0.441, P < 0.001) and NLR2 (r = 0.241, P = 0.009) were both positively correlated with seizure severity. Conclusions: Seizures were correlated with the alterations of systemic inflammation reflected by leukocyte and NLR. NLR1 and admission leukocyte were both independently associated with acute epileptic seizures. Higher NLR1 was associated with status epilepticus and independently predicted the tendency of the following epileptic seizures. NLR2 was significantly associated with ASDs taken. Besides, NLR may be used as a biomarker for seizure severity.

Using short knee radiographs to predict the coronal alignment after TKA: Is it an accurate proxy for HKA on full-length images?

BACKGROUND: The postoperative clinical outcomes has been extensively demonstrated to correlate with the coronal alignment after total knee arthroplasty (TKA). However, in different studies, either the hip-knee-ankle angle (HKA) on a full-length radiograph or the femorotibial angle (FTA) on a short knee film was used to categorize the postoperative coronal alignment. Meanwhile, several different FTA ranges were regarded as neutral alignment in different studies. As a result, it is still unknown that how FTA on short knee films and HKA related to each other. The FTA may be able to become an accurate proxy of HKA to predict the coronal alignment. The purpose of this study was to explore the correlation between the FTA and the HKA after TKA and to find the most accurate FTA range. METHODS: About 223 patients were included in this study and standard weight-bearing short knee films as well as full-length radiographs were acquired. The pre- and postoperative FTA, as well as the postoperative anatomical lateral distal femoral angle (aLDFA) and anatomical medial proximal tibial angle (aMPTA) were measured on short knee films by two orthopedic surgeons independently. On full-length films, the pre- and postoperative FTA, the pre- and postoperative HKA, as well as the postoperative mechanical lateral distal femoral angle (mLDFA) and mechanical medial proximal tibial angle (mMPTA) were also recorded by two other surgeons independently. Pearson correlation analysis was performed to compare FTA and HKA, aMTPA and mMTPA, aLDFA and mLDFA, respectively. RESULTS: The postoperative FTA and HKA had a good correlation (r = 0.86). The agreements were reached 82.7%, 71.0%, and 68.2% of all patients using three previously reported FTA ranges. When analyzing the independent alignment of the tibial tray and the femoral component, 84.1% and 57.9% of all patients was reached an agreement on the classification. CONCLUSIONS: On most occasions, the consistence between the FTA and HKA in assessing the coronal limb alignment of the lower extremity and the tibial component is satisfactory. However, the postoperative full-length film is still needed to evaluate accurately the coronal alignment of the femoral component.

Amplitude of Low-Frequency Fluctuation With Different Clinical Outcomes in Patients With Generalized Tonic-Clonic Seizures.

Background: Generalized tonic-clonic seizures (GTCS) are associated with significant disability and sudden unexpected death when they cannot be controlled. We aimed to explore the underlying neural substrate of the different responses to antiseizure drugs between the seizure-free (SF) and non-seizure-free (NSF) patients with GTCS through the amplitude of low-frequency fluctuation (ALFF) method. Methods: We calculated ALFF among the SF group, NSF group, and healthy controls (HCs) by collecting resting-state functional magnetic resonance imaging (rs-fMRI) data. One-way ANOVA was used to compare the ALFF of the three groups, and post-hoc analysis was done at the same time. Pearson's correlation analysis between ALFF in the discrepant brain areas and the clinical characteristics (disease course and age of onset of GTCS) was calculated after then. Results: A significant group effect was found in the right fusiform gyrus (R.FG), left fusiform gyrus (L.FG), left middle occipital gyrus (L.MOG), right inferior frontal gyrus (R.IFG), right precentral gyrus (R.PreG), right postcentral gyrus (R.PostG), and left calcarine sulcus (L.CS). The SF and NSF groups both showed increased ALFF in all discrepant brain areas compared to HCs except the R.IFG in the NSF group. Significantly higher ALFF in the bilateral FG and lower ALFF in the R.IFG were found in the NSF group compared to the SF group. Conclusions: Higher ALFF in the bilateral FG were found in the NSF group compared to the SF and HC groups. Our findings indicate that abnormal brain activity in the FG may be one potential neural substrate to interpret the failure of seizure control in patients with GTCS.

Decrease in Serum Levels of Adiponectin and Increase in 8-OHdG: a Culprit for Cognitive Impairment in the Elderly Patients with Type 2 Diabetes.

BACKGROUND: Adiponectin and 8-Hydroxy-2'-deoxyguanosine (8-OHdG) are identified as important biomarkers in the pathogenesis process of type 2 diabetes mellitus (T2DM). Whether adiponectin and 8-OHdG have a relation to cognitive decline in the elderly T2DM patients has been poorly understood. The aim of this study was to evaluate the effects of adiponectin and 8-OHdG in the elderly patients with T2DM and to determine the role of adiponectin and 8-OHdG in the cognitive impairment of the elderly patients with T2DM. METHODS: 57 individuals were recruited and analyzed , with 26 cases of T2DM without cognitive impairment and 31 cases of T2DM with cognitive impairment. All of them underwent an examination of diabetes scales and blood glucose at different times. A primary diagnosis of diabetes was in line with the diagnosis criteria set by the American Diabetes Association (ADA). Statistical significance was defined as a P-value of less than 0.05. RESULTS: The variables of sex, age, body mass index (BMI), hypertension, diabetes, metabolic syndrome, lacunar cerebral infarction, smoking and drinking in T2DM patients without cognitive impairment and with cognitive impairment showed no difference according to the univariate analysis exploring each variable separately (p>0.05). A significant difference was observed in the serum levels of adiponectin and 8-OHdG and the scales of MMSE and MoCA (p<0.05). Therefore, it was inferred that there is no correlation between glucose metabolic value and cognitive outcome of T2DM patients. Serum levels of adiponectin and 8-OHdG could act as biomarkers of cognitive impairment degree in the elderly T2DM patients. CONCLUSION: Serum levels of adiponectin and 8-OHdG could act as specific and sensitive biomarkers for the early diagnosis and treatment of cognitive impairment in elderly T2DM patients. Serum levels of adiponectin and 8-OHdG have a close relation to the neurological cognitive outcome of the elderly T2DM patients.