Intraoperative management during liver transplantation in the child with mitochondrial depletion syndrome: A case report.

INTRODUCTION: Mitochondrial DNA depletion syndrome (MDS) is a kind of autosomal recessive genetic disorder associated with a reduction in mitochondrial DNA (mtDNA) copy number caused by mutations in nuclear genes during nucleotide synthesis, which affects the energy production of tissues and organs. Changes in hemodynamics during liver transplantation may lead to high energy-demanding organs and tissues being vulnerable. This report described the intraoperative management during liver transplantation in a child with MDS. Ultimately, the child was discharged smoothly without any complications. PRESENTATION OF THE CASE: A five-year-old boy was diagnosed with mitochondrial depletion syndrome preoperatively and scheduled for living donor liver transplantation. The incidence of postreperfusion syndrome (PRS) could not be avoided for 30 min after opening, despite our best efforts to aggressively prevent it before opening. While ensuring hemodynamic stability, we actively prevented and adopted high-energy-demand organ protection strategies to reduce the incidence of postoperative complications. Finally, the child was discharged 28 days after the operation, and no other complications were found. DISCUSSION: Liver transplantation can be performed for liver failure in this disease to improve the quality of life and prolong the life of patients. As this child has mitochondrial DNA depletion syndrome, the disruption of cellular energy generation caused by mitochondrial malfunction puts high-energy-demanding organs and tissues at risk during surgery. It motivates us to pay closer attention to the prevention and treatment of PRS in anesthetic management to minimize damage to the child's organs and tissues with high energy demands. CONCLUSIONS: This report describes the intraoperative management during liver transplantation in a child with mitochondrial depletion syndrome. To increase the safety of perioperative anesthesia and reduce mortality in patients with mitochondrial disease, for such patients, maintaining an acid-base balance and a stable internal environment is essential. We should also pay attention to protecting body temperature, using vasoactive drugs beforehand to lessen the incidence of PRS, and protecting high-energy-demanding organs afterward.

Clinical efficacy of greater trochanter osteotomy with tension wire fixation in total hip arthroplasty for Crowe type IV developmental dysplasia of the hip.

OBJECTIVE: The choice of osteotomy in joint replacement surgery for Crowe type IV developmental dysplasia of the hip (DDH) is a challenging and controversial procedure. In this study, we compared the clinical efficacy of a combination of greater trochanter osteotomy and tension wire fixation with that of subtrochanteric osteotomy. METHODS: We performed 15 primary total hip arthroplasty (THA) procedures between January 2016 and July 2020 on 13 patients with a combination of greater trochanter osteotomy and tension wire fixation (the GTT group) and 12 THA procedures in 11 patients using subtrochanteric osteotomy (the STO group). The mean follow-up was 2.8 years (range 2.2-4.5 years) in the GTT group and 2.6 years (range 2.5-4.3 years) in the STO group. Clinical scores and radiographic results were evaluated during the final follow-up for the 15 hips in the GTT group and 12 hips in the STO group. RESULTS: Postoperative Harris hip scores, implant position, and the surgery time did not differ between the treatment groups. There were no differences in preoperative leg length discrepancy LLD (P = 0.46) and postoperative LLD (P = 0.56) between the two groups. Bone union occurred within 6 months after surgery in 12 hips in the GTT group (92.3%) and in 9 hips (81.8%) in the STO group. One case in the GTT group and two cases in the STO group had nonunion, and additionally, there was one case of postoperative nerve injury in the STO group, while no symptoms of nerve damage were observed in the GTT group. CONCLUSION: The GTT method demonstrated many advantages and reliable clinical results for Crowe type IV DDH patients undergoing THA. This is a surgical method that warrants further development and promotion clinically.

Phylogenetic analysis based on the complete mitochondrial genome of Discogobio brachyphysallidos (Cypriniformes: Cyprinidae) suggests the need for taxonomic revision at the genus level.

Discogobio brachyphysallidos Huang 1989 is a Cyprinidae fish species that is endemic to the upper Pearl River. In the present study, the complete mitochondrial genome of D. brachyphysallidos collected from the Nanpanjiang River was sequenced and annotated. The mitochondrial genome encompassed 13 protein-coding genes, two ribosomal RNA (rRNA) genes, 22 transfer RNA (tRNA) genes, and the control region (D-loop). The total length of the mitochondrial genome was determined to be 16,594 base pairs (bp), with a GC content of 41.7%. Phylogenetic analyses revealed that D. brachyphysallidos may be a sister to D. longibarbatus and D. macrophysallidos. These findings provide insight into the genetic information and phylogenetic relationships of D. brachyphysallidos.

A Deep Learning-based in silico Framework for Optimization on Retinal Prosthetic Stimulation.

We propose a neural network-based framework to optimize the perceptions simulated by the in silico retinal implant model pulse2percept. The overall pipeline consists of a trainable encoder, a pre-trained retinal implant model and a pre-trained evaluator. The encoder is a U-Net, which takes the original image and outputs the stimulus. The pre-trained retinal implant model is also a U-Net, which is trained to mimic the biomimetic perceptual model implemented in pulse2percept. The evaluator is a shallow VGG classifier, which is trained with original images. Based on 10,000 test images from the MNIST dataset, we show that the convolutional neural network-based encoder performs significantly better than the trivial downsampling approach, yielding a boost in the weighted F1-Score by 36.17% in the pre-trained classifier with 6×10 electrodes. With this fully neural network-based encoder, the quality of the downstream perceptions can be fine-tuned using gradient descent in an end-to-end fashion.

Paying attention to the value of thrombelastography and the impact of postreperfusion syndrome on outcomes of liver transplantation.

Only limited information is available about the connection between massive blood transfusion and postoperative survival rates in pediatric liver transplantation. The aim of Gordon's study was to examine the potential impact of perioperative transfusion on postoperative complications and death in young children receiving pediatric living-donor liver transplantation (PLDLT). The authors concluded that transfusion of a red blood cell volume higher than 27.5 mL/kg during the perioperative period is associated with a significant increase in short- and long-term postoperative morbidity and mortality after PLDLT. However, viscoelastic coagulation monitoring was not utilized in the study; instead, only conventional coagulation monitoring was conducted. Overall, the choice of blood coagulation monitoring method during blood transfusion can have a significant impact on patient prognosis. Several studies have shown that the viscoelastic coagulation testing such as thrombelastography (TEG) is highly sensitive and accurate for diagnosing coagulation dysfunction. Indeed, a TEG-guided blood transfusion strategy can improve prognosis. Moreover, postreperfusion syndrome is one of the most common complications of liver transplantation and an important factor affecting the prognosis of patients and should also be included in regression analysis.

Risk factors for myocardial injury during living donor liver transplantation in pediatric patients with biliary atresia.

BACKGROUND: Cold ischemia-reperfusion of the liver is an inevitable occurrence in liver transplantation that may also cause damage to the heart. Perioperative myocardial injury during liver transplantation can increase the incidence of postoperative mortality, but there is little research on the incidence of myocardial injury in children who undergo living donor liver transplantation (LDLT). Therefore, this study mainly explores the independent risk factors for myocardial injury in children who undergo LDLT. AIM: To analyze the data of children who underwent LDLT to determine the risk factors for intraoperative myocardial injury. METHODS: We retrospectively analyzed the inpatient records of pediatric patients who underwent LDLT in Tianjin First Central Hospital from January 1, 2020, to January 31, 2022. Recipient-related data and donor-related data were collected. The patients were divided into a myocardial injury group and a nonmyocardial injury group according to the value of the serum cardiac troponin I at the end of surgery for analysis. Univariate analysis and multivariate logistic regression were used to evaluate the risk factors for myocardial injury during LDLT in pediatric patients. RESULTS: A total of 302 patients met the inclusion criteria. The myocardial injury group had 142 individuals (47%), and the nonmyocardial injury group included 160 patients (53%). Age, height, and weight were significantly lower in the myocardial injury group (P < 0.001). The pediatric end-stage liver disease (PELD) score, total bilirubin, and international standardized ratio were significantly higher in the myocardial injury group (P < 0.001). The mean arterial pressure, lactate, hemoglobin before reperfusion, duration of the anhepatic phase, cold ischemic time, incidence of postreperfusion syndrome (PRS), and fresh frozen plasma transfusion were significantly different between the two groups (P < 0.05). The postoperative intensive care unit stay and peak total bilirubin values in the first 5 d after LDLT were significantly higher in the myocardial injury group (P < 0.05). The pediatric patients with biliary atresia in the nonmyocardial injury group who underwent LDLT had a considerably higher one-year survival rate than those in the myocardial injury group (P = 0.015). Multivariate logistic regression revealed the following independent risk factors for myocardial injury: a high PELD score [odds ratio (OR) = 1.065, 95% confidence interval (CI): 1.013-1.121; P = 0.014], a long duration of the anhepatic phase (OR = 1.021, 95%CI: 1.003-1.040; P = 0.025), and the occurrence of intraoperative PRS (OR = 1.966, 95%CI: 1.111-3.480; P = 0.020). CONCLUSION: A high PELD score, a long anhepatic phase duration, and the occurrence of intraoperative PRS were independent risk factors for myocardial injury during LDLT in pediatric patients with biliary atresia.

Impact of patent foramen ovale on short-term outcomes in children with biliary atresia undergoing living donor liver transplantation: a retrospective cohort study.

OBJECTIVE: To investigate the impact of patent foramen ovale (PFO) on the short-term outcomes of living donor liver transplantation (LDLT) in children with biliary atresia. METHODS: With the approval of the hospital ethics committee, 304 children with biliary atresia who underwent LDLT in our center from January 2020 to December 2021 were enrolled. According to the results of echocardiography before the operation, the subjects were divided into the PFO group (n = 73) and the NoPFO group (n = 231). The baseline characteristics; intraoperative recipient-related data and donor-related data; incidence of postreperfusion syndrome (PRS); postoperative mechanical ventilation time; ICU stay duration; postoperative hospital stay duration; liver function index; incidences of postoperative complications including acute renal injury (AKI), graft dysfunction, hepatic artery thrombosis (HAT) and portal vein thrombosis (PVT); and one-year survival rate were compared between the two groups. RESULTS: The median age in the PFO group was 6 months and that in the NoPFO group was 9 months (P < 0.001), and the median height (65 cm) and weight (6.5 kg) in the PFO group were significantly lower than those in the NoPFO group (68 cm, 8.0 kg) (P < 0.001). The preoperative total bilirubin level (247 vs. 202 umol/L, P = 0.007) and pediatric end-stage liver disease (PELD) score (21 vs. 16, P = 0.001) in the PFO group were higher than those in the NoPFO group. There were no significant differences in the intraoperative PRS incidence (46.6% vs. 42.4%, P = 0.533 ), postoperative mechanical ventilation time (184 vs. 220 min, P = 0.533), ICU stay duration (3.0 vs. 2.5 d, P = 0.267), postoperative hospital stay duration (22 vs. 21 d, P = 0.138), AKI incidence (19.2% vs. 24.7%, P = 0.333), graft dysfunction incidence (11.0% vs. 12.6%, P = 0.716), HAT incidence (5.5% vs. 4.8%, P = 0.762), PVT incidence (2.7% vs. 2.2%, P = 0.675) or one-year survival rate (94.5% vs. 95.7%, P = 0.929) between the two groups. CONCLUSION: The presence of PFO has no negative impact on short-term outcomes in children with biliary atresia after LDLT.

Risk factors for postreperfusion syndrome during living donor liver transplantation in paediatric patients with biliary atresia: a retrospective analysis.

BACKGROUND: Living donor liver transplantation (LT) is the main treatment for paediatric biliary atresia (BA) in Asia. During LT, a series of haemodynamic changes often occur during LT reperfusion, which is called postreperfusion syndrome (PRS), and PRS is related to a prolonged postoperative hospital stay, delayed recovery of graft function and increased mortality. To reduce adverse reactions after paediatric living donor LT (LDLT), our study's objectives were to ascertain the incidence of PRS and analyse possible risk factors for PRS. METHODS: With the approval of the Ethics Committee of our hospital, the clinical data of 304 paediatric patients who underwent LDLT from January 2020 to December 2021 were analysed retrospectively. According to the presence or absence of PRS, the paediatric patients were divided into the non-PRS group and the PRS group. Independent risk factors of PRS were analysed using logistic regression analysis. RESULTS: PRS occurred in 132 recipients (43.4%). The peak values of AST (816 (507-1625) vs 678 (449-1107), p=0.016) and ALT (675 (415-1402) vs 545 (389-885), p=0.015) during the first 5 days after LDLT in paediatric patients with PRS were significantly higher than those in the non-PRS group. Meanwhile, the paediatric patients in the PRS group had longer intensive care unit stays and hospital stays, as well as lower 1-year survival rates. Graft cold ischaemic time (CIT) ≥90 min (OR (95% CI)=5.205 (3.094 to 8.754)) and a temperature <36°C immediately before reperfusion (OR (95% CI)=2.973 (1.669 to 5.295)) are independent risk factors for PRS. CONCLUSIONS: The occurrence of hypothermia (<36.0℃) in children immediately before reperfusion and graft CIT≥90 min are independent risk factors for PRS. PRS was closely related to the postoperative adverse outcomes of paediatric patients.

Superior mesenteric artery embolism after radiofrequency ablation in regularly anticoagulated patients with paroxysmal atrial fibrillation: a case report.

BACKGROUND: Superior mesenteric artery embolism (SMAE) is a rare cause of acute abdomen, and the fatality rate is extremely high if it is not diagnosed and treated in time. Due to the lack of knowledge and experience of nonspecialist physicians, it is easy to misdiagnose. Radiofrequency ablation (RFA) has become the first-line treatment strategy for atrial fibrillation (AF). Thromboembolic events are some of the major complications after RFA, whereas SMAE is rarely reported. CASE PRESENTATION: A 70 year-old woman with paroxysmal AF who regularly took anticoagulant drugs for 3 months experienced abdominal pain after RFA. At the outset, she was misdiagnosed as mechanical intestinal obstruction. When the patient presented with blood in the stool, abdominal enhancement computed tomography was conducted and showed a small bowel perforation. Immediate laparotomy was performed, and the final diagnosis was SMAE. CONCLUSION: It is suggested that for unexplained abdominal pain after RFA of AF, the possibility of SMAE should be considered, and a targeted examination should be carried out in time to confirm the diagnosis and give appropriate treatment.

Circ_0003789 Facilitates Gastric Cancer Progression by Inducing the Epithelial-Mesenchymal Transition Through the Wnt/ß-Catenin Signaling Pathway.

Background: The role of circular RNAs in the pathogenesis of gastric cancer (GC) has been well documented by numerous studies. However, whether circ_0003789 plays a role during GC progression remains to be determined. Thus, this study investigated the biological functions of circ_0003789 during GC progression. Materials and Methods: Circ_0003789 expression was determined using quantitative real-time polymerase chain reaction in GC and matched para-carcinoma normal tissues. Functional experiments were performed to estimate changes in the proliferation, apoptosis, migration, and invasion of GC cells treated to silence circ_0003789. E-cadherin, vimentin, Wnt3a, and ß-catenin expression was determined using immunofluorescence staining and Western blot assays. Xenograft tumor growth and Ki67 expression were also evaluated in vivo. Results: Circ_0003789 was upregulated in GC tissues and cells, and its upregulation positively correlated with poor tumor differentiation, distal metastasis, and advanced clinical stage. Silencing circ_0003789 inhibited GC cell proliferation, migration, invasion, and the epithelial-mesenchymal transition (EMT), both in vitro and in vivo. Mechanistically, the Wnt/ß-catenin signaling pathway was repressed by circ_0003789 silencing. Conclusions: Circ_0003789 facilitates GC progression by inducing the EMT through the Wnt/ß-catenin signaling pathway.

Clinical diagnostic value and analysis of MRI combined with ultrasound in prenatal pernicious placenta previa with placenta accreta.

BACKGROUND: Placenta previa is one dangerous disease which threatens the health of pregnant women and their fetuses. The purpose of this study was to evaluate the clinical value of ultrasound combined with magnetic resonance imaging (MRI) in screening for placenta previa complicated by placenta accreta. METHODS: Seventy patients with abnormal fetal position admitted to our hospital from January 2019 to January 2020 were selected for the study. Patients were diagnosed by ultrasound alone, MRI alone, and ultrasound combined with MRI. Diagnostic accuracy, sensitivity, specificity and false positive and negative diagnosis rates were evaluated against the postoperative pathological examinations of the patients. RESULTS: The diagnostic accuracy, sensitivity and false negative rate for ultrasound combined with MRI were 86.27%, 97.78% and 72.00%, respectively. These results were significantly superior to those of MRI or ultrasound alone (P<0.05). The specificity and false positive rate for ultrasound combined with MRI were 13.73% and 5.26%, respectively, which were not significantly different from those for MRI or ultrasound alone (P>0.05). CONCLUSIONS: Compared with ultrasound or MRI alone, ultrasound combined with MRI has higher accuracy and sensitivity in the diagnosis of placenta previa with placenta accreta, along with lower false positive diagnosis rates. These findings are clinically important for improving the diagnostic efficiency.

Humans navigate with stereo olfaction.

Human navigation relies on inputs to our paired eyes and ears. Although we also have two nasal passages, there has been little empirical indication that internostril differences yield directionality in human olfaction without involving the trigeminal system. By using optic flow that captures the pattern of apparent motion of surface elements in a visual scene, we demonstrate through formal psychophysical testing that a moderate binaral concentration disparity of a nontrigeminal odorant consistently biases recipients' perceived direction of self-motion toward the higher-concentration side, despite that they cannot verbalize which nostril smells a stronger odor. We further show that the effect depends on the internostril ratio of odor concentrations and not the numeric difference in concentration between the two nostrils. Taken together, our findings provide behavioral evidence that humans smell in stereo and subconsciously utilize stereo olfactory cues in spatial navigation.

Encapsulation of emulsions by a novel delivery system of fluid core-hard shell biopolymer particles to retard lipid oxidation.

Colloidal delivery systems could be designed to retard lipid oxidation in foods, thereby extending their shelf-lives and improving their nutritional quality. In this study, a class of novel fluid core-hard shell biopolymer particles with lipid droplets being encapsulated in the biopolymer has been designed and fabricated to increase their lipid oxidative stability. This was achieved by injecting a mixture of Tween 80-coated lipid droplets, xanthan gum, and calcium ions into a sodium alginate solution at either pH 3 or 7. The viscosity, hardness, microstructure, physical stability, and chemical stability of the droplet-loaded fluid core-hard shell (FCHS) biopolymer particles were then measured. The results indicated that the FCHS biopolymer particles had thinner, denser, and harder shells at pH 3 than at pH 7. The thickness of the alginate biopolymer particle walls could be modulated by varying the xanthan gum to alginate ratio used during fabrication. The lipid oxidation measurements indicated that the primary (PV) and secondary (TBARS) reaction products decreased by approximately 60% and 75%, respectively, compared to the control after 13 days of storage at pH 3. These results indicate that the encapsulation of lipid droplets within the FCHS biopolymer particles substantially increased their oxidative stability. The biopolymer particles developed in this study may have promising applications in various food, pharmaceutical, and cosmetic products for retarding lipid oxidation.

Ubiquitin-specific protease 3 targets TRAF6 for deubiquitination and suppresses IL-1ß induced chondrocyte apoptosis.

Traditionally, the development of osteoarthritis (OA) is associated with factors such as aging and injure, but more and more epidemiological and biological evidence suggests that the disease is closely related to metabolic syndrome and metabolic components. Ubiquitin-specific protease 3(USP3), a member of the USPs family, is a specific protease capable of cleavage of ubiquitin chains linked by proline residues. In our presented study, we firstly found that USP3 expression level was decreased in OA. USP3 overexpression inhibited IL-1ß induced chondrocytes apoptosis and nuclear factor κB (NF-κB) activation. USP3 knockdown induced chondrocytes apoptosis and activated NF-κB pathway. USP3 interacts with TRAF6 (tumor necrosis factor-receptor-associated factor 6), which is an essential adaptor protein for the NF-κB (nuclear factor κB) signaling pathway and plays important roles in inflammation and immune response. IL-1ß treatment up-regulated the polyubiquitination of TRAF6 in chondrocytes, which was attenuated when USP3 was forced expression. Our study mechanistically links USP3 to TRAF6 in osteoarthritis development. Moreover, these data support the pursuit of USP3 and TRAF6 as potential targets for osteoarthritis therapies.

Arthroscopic lateral retinacular release, medial retinacular plication and partial medial tibial tubercle transfer for recurrent patellar dislocation.

OBJECTIVE: To assess the efficacy of a therapeutic protocol composed of arthroscopic lateral retinacular release, medial retinacular plication, and partial medial tibial tuberosity transfer for patients with recurrent patellar dislocation. METHOD: 71 patients, 11 males and 60 females and a total of 77 knees, with recurrent dislocation of the patella were enrolled between 1998 and 2012. The average age of the patients was 19.5 years and 67 of them had previous knee trauma history. Tibial tubercle avulsion fractures were all surgically treated without complications like dysplasia in the femoral trochlear groove or valgus deformity. The Q angle, sulcus angle, patella-femoral trochlear congruence angle and lateral patellofemoral angle were measured on X-ray, while tibial tubercle-trochlear groove (TT-TG) distance was measure on CT scans, before the arthroscopic operation. RESULT: 69 patients were followed-up for 2-16 years (average of 7.2 years), while 2 patients were lost during follow-up. Among the patients with follow-up, one patient had recurrent patella dislocation two months after the operation. Q angle decreased from 13.2° to 9.2° in male patients (P < 0.05) and from 21.0° to 15.4° in female patients (P < 0.05). On average, the patella-femoral trochlear congruence angle decreased from 24.2 ± 6.8° to -2.1 ± 5.8° (P < 0.05) and the lateral patellofemoral angle increased from -2.0 ± 5.2° to 10.9 ± 4.0° (P < 0.05). TT-TG distance decreased from 19.8 ± 2.1 mm to 13.6 ± 1.8 mm (P < 0.01). Mean Lysholm score increased from 45.6 ± 4.8 to 92.3 ± 10.8 (P < 0.05) and, IKDC score increased from 48.3 ± 6.8 to 94.3 ± 8.4 (P < 0.05). CONCLUSION: As evidenced by minimal trauma and markedly improved knee joint function, the proposed therapeutic protocol demonstrated clear benefits for patients with recurrent patella dislocation.

[CONDITIONS OF SYNOVIAL MESENCHYMAL STEM CELLS DIFFERENTIATING INTO FIBROCARTILAGE CELLS].

OBJECTIVE: To explore the conditions of synovial derived mesenchymal stem cells (SMSCs) differentiating into the fibrocartilage cells by using the orthogonal experiment. METHODS: The synovium was harvested from 5 adult New Zealand white rabbits, and SMSCs were separated by adherence method. The flow cytometry and multi-directional differentiation method were used to identify the SMSCs. The conditions were found from the preliminary experiment and literature review. The missing test was carried out to screen the conditions and then 12 conditions were used for the orthogonal experiment, including transforming growth factor ß1 (TGF-ß1), bone morphogenic protein 2 (BMP-2), dexamethasone (DEX), proline, ascorbic acid (ASA), pyruvic acid, insulin + transferrin + selenious acid pre-mixed solution (ITS), bovin serum albumin (BSA), basic fibroblast growth factor (bFGF), intermittent hydraulic pressure (IHP), bone morphogenic protein 7 (BMP-7), and insulin-like growth factor (IGF). The L60 (212) orthogonal experiment was designed using the SPSS 18.0 with 2 level conditions and the cells were induced to differentiate on the small intestinal submucosa (SIS)-3D scaffold. The CD151+/CD44+ cells were detected with the flow cytometry and then the differentiation rate was recorded. The immumohistochemical staining, cellular morphology, toluidine blue staining, and semi-quantitative RT-PCR examination for the gene expressions of sex determining region Y (SRY)-box 9 gene (Sox9), aggrecan gene (AGN), collagen type I gene (Col I), collagen type II gene (Col II), collagen type IX gene (Col IX) were used for result confirmation. The differentiation rate was calculated as the product of CD151/CD44+ cells and cells with Col I high expression. The grow curve was detected with the DNA abundance using the PicoGreen Assay. The visual observation and the variances analysis among the variable were used to evaluate the result of the orthogonal experiment, 1 level interaction was considered. The q-test and the least significant difference (LDS) were used for the variance analysis with a type III calibration model. The test criteria (a) was 0.05. RESULTS: The cells were certified as SMSCs, the double-time of the cells was 28 hours. During the differentiation into the fibrocartilage, the volume of the SIS-3D scaffold enlarged double every 5 days. The scaffolds were positively stained by toluidine blue at 14 days. The visual observation showed that high levels of TGF-ß1 and BMP-7 were optimum for the differentiation, and BMP-7 showed the interaction with BMP-2. The conditions of DEX, ASA, ITS, transferrin, bFGF showed decreasing promotional function by degrees, and the model showed the perfect relevance. P value was 0.000 according to the variance analysis. The intercept analysis showed different independent variables brought about variant contribution; the TGF-ß1, ASA, bFGF, IGF, and BMP-7 were more remarkable, which were similar to the visual observation. CONCLUSION: In the process of the SMSCs differentiation into the fibrocartilage, the concentrations of TGF-ß1, ASA, bFGF, and IGF reasonably can improve the conversion rate of the fibrocartilage cells. The accurate conditions of the reaulatory factor should be explored further.

[PERIOPERATIVE BLOOD MANAGEMENT STRATEGIES FOR JOINT ARTHROPLASTY].

OBJECTIVE: To summarize the perioperative blood management strategies for joint arthroplasty. METHODS: The literature concerning preoperative, intraoperative, and postoperative blood management was reviewed and summarized. RESULTS: At present, a variety of blood management and conservation strategies are available. Preoperative strategies include iron supplementation, erythropoietin (EPO), and preoperative autologous donation (PAD). Intraoperative options include acute normovolemic hemodilution (ANH), antifibrinolytics, and the use of a tourniquet. Postoperative strategies include the use of reinfusion systems and guided transfusion protocols. Preoperatively, administration of either simple EPO or a combination of EPO and PAD can be efficacious in anemic patients. Intraoperatively, tourniquet use and tranexamic acid can effectively control bleeding. Postoperatively, appropriate transfusion indications can avoid unnecessary blood transfusions. CONCLUSION: Perioperative blood management strategies for joint arthroplasty should be integrated for the individual patient using a variety of ways to reduce perioperative blood loss and blood transfusion, and promote the rehabilitation of patients.

Lack of efficacy of prophylactic application of antibiotic-loaded bone cement for prevention of infection in primary total knee arthroplasty: results of a meta-analysis.

BACKGROUND: Deep incisional surgical site infection (SSI) is a devastating and costly complication of primary total knee arthroplasty (TKA). The effectiveness of antibiotic-loaded bone cement (ALBC) in preventing these infections remains controversial. METHODS: A meta-analysis was conducted to assess the efficacy of ALBC in preventing deep infection in primary TKA after a detailed and systematic search of the PubMed, Embase, CNKI, and Cochrane databases had been performed to identify appropriate comparative trials on the prophylactic use of ALBC in primary TKA. RESULTS: Five comparative trials were included. In total, 3,461 patients (ALBC group) received ALBC, whereas 3,176 patients (non-antibiotic-loaded cement; NALBC group) did not. The incidence of deep incisional SSI in the ALBC group was 1.32% (n=46) whereas the incidence in the NALBC group was 1.89% (n=60), figures which are not significantly different. No adverse events associated with ALBC were reported in any studies. CONCLUSION: Statistical analysis did not reveal a significantly different incidence of deep or superficial SSI in patients receiving and not receiving antibiotic-loaded cement. The prophylactic application of ALBC thus did not show efficacy in primary TKA. More large-sample studies are required to confirm this finding.