Serum periostin level is not sufficient to serve as a clinically applicable biomarker of osteoarthritis.

BACKGROUND: Emerging knowledge has highlighted the role of periostin (POSTN) in osteoarthritis (OA) process; however, whether POSTN is suitable as a biomarker of OA remains unclear. This study aimed to investigate the potential value of POSTN as a biomarker of OA. METHODS: Ten 6-month-old female Sprague-Dawley (SD) rats were used in this study. Five rats underwent ovariectomy (OVX) operation and the others were carried out sham operation. Thirty-two patients with OA and eighteen patients who had meniscus injuries or ligament injuries but with intact articular cartilages were recruited in this study from January to July 2019 at the Peking University International Hospital. We first detected the expression of POSTN in the cartilage of OVX induced OA rats and different compartments of the knee joint in patients with OA using immunohistochemistry. Besides, serum POSTN levels in patients with or without OA were examined using enzyme-linked immunosorbent assay (ELISA). The associations among serum POSTN levels, clinical symptoms, and radiological severity were assessed according to the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores and, Kellgren-Lawrence (KL) grading, respectively. Finally, multivariable cumulative link models were established to evaluate the validity of serum POSTN level as a predictor of knee OA. RESULTS: The significantly higher POSTN expression was found in OVX-OA rats than Sham rats, while, the expression of POSTN was significantly higher in the torn cartilage of patients with OA. However, the serum POSTN level did not differ significantly between patients with and without OA. Additionally, we found no remarkable associations between serum POSTN level and WOMAC scores and KL grading. Subsequent analysis revealed that serum POSTN was not a significant predictor of OA. CONCLUSION: Thus, although POSTN may be involved OA process and local POSTN is valuable in disease diagnosis and distinguishing of the severity of disease, its serum level is not sufficient to serve as a candidate biomarker of OA given the current analysis technology.

Factors Influencing Nonunion and Fracture Following Biological Intercalary Reconstruction for Lower-Extremity Bone Tumors: A Systematic Review and Pooled Analysis.

OBJECTIVES: To determine nonunion rate, fracture rate, and their risk factors following biological intercalary reconstruction for lower extremity bone tumors. METHODS: A systematic review and pooled analysis were conducted. PubMed, Embase, and Wiley Cochrane Library were searched from inception up to June 01, 2020. Studies concerning biological intercalary reconstruction after resection of lower extremity bone tumors were included. Overall nonunion and fracture rates were calculated. For studies reporting patient outcomes individually with precise graft characteristics and fixation methods, the individual data were extracted. Patients with demographical and clinical characteristics, including age, sex, tumor location, graft characteristics, and fixation method, were pooled for a multivariate analysis. For each factor of interest, odds ratio (OR), 95% confidence interval (95% CI), and p-value from logistic regression were reported. RESULTS: A total of 2776 articles were identified from the initial literature search and 76 studies (2052 patients) were included. Sixty-nine studies were case series and seven were comparative studies. The overall nonunion rate was 19% (382/2052; range: 0%-53%), and the overall fracture rate was 17% (344/2052; range: 0%-75%). Thirty of the 76 studies (362 patients) reported patients' characteristics individually and were thus included in the pooled multivariate analysis. Intramedullary nail fixation was associated with a significantly higher nonunion rate compared to plate fixation (OR = 2.2, 95% CI: 1.23-4.10, p = 0.009). Reconstruction with a vascularized fibula graft had a statistically non-significant lower nonunion rate than reconstruction without the graft (OR = 0.6, 95% CI: 0.34-1.07, p = 0.086). Devitalized autografts had a lower fracture risk than allografts (OR = 0.3, 95% CI: 0.14-0.64, p = 0.002), and males tended to have higher fracture risk than females (OR = 2.1, 95% CI: 1.00-4.44, p = 0.049). CONCLUSIONS: Reconstruction with intramedullary nail fixation is related to an elevated risk of nonunion. Allografts and males have a higher fracture risk than devitalized autografts and females, respectively. Further high-quality comparative analyses with large sample sizes and adequate follow-up duration are needed to validate these findings.

Potential Value of Matrix Metalloproteinase-13 as a Biomarker for Osteoarthritis.

Background: Emerging knowledge has highlighted the role of matrix metalloproteinase (MMP)-13 in osteoarthritis (OA); however, the suitability of MMP-13 as a biomarker for OA remains unclear. Therefore, this study aimed to assess the potential value of MMP-13 as a biomarker for OA. Methods: The study enrolled 51 patients, of which 33 had advanced varus OA and 18 did not have OA. Immunohistochemistry and western blotting analyses were performed to measure MMP-13 activity in the cartilage and subchondral bone of patients with OA. Enzyme-linked immunosorbent assay was used to measure serum MMP-13 levels in patients with or without OA. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was used to assess the association between serum MMP-13 levels and clinical symptoms. Furthermore, the association between serum MMP-13 levels and radiological severity of OA was evaluated using the Kellgren-Lawrence (KL) grading system. Finally, we built the proportional odds logistic regression models to evaluate serum MMP-13 levels as a potential predictor for OA. Results: MMP-13 levels were significantly higher in the severe-worn cartilage of the medial tibial plateau than in the relatively intact portion of the lateral cartilage (p < 0.05). This was contrary to the findings for MMP-13 differential expression in the subchondral bone in knee OA (p < 0.05). Patients with OA had significantly higher serum MMP-13 levels compared with patients without OA. Additionally, remarkable associations among serum MMP-13 levels, WOMAC scores, and KL grading scores were found in the end-stage OA. Furthermore, the subsequent analysis suggested that serum MMP-13 level was a significant predictor for OA. Conclusion: MMP-13 is valuable for diagnosing, measuring disease severity, and predicting OA in the advanced period of the disease, suggesting that it has potential possibility as a biomarker for OA. However, the underlying mechanisms and clinical application of MMP-13 as a biomarker for OA require to be further investigated.

Assessment of the Viability and Union Feature of Diaphysis Reconstruction Using Pasteurized Tumor Bone and Intramedullary Free Fibular After Tumor Resection.

BACKGROUND: Reconstruction using pasteurized tumor bone (PTM) and intramedullary-placed vascularized free fibular (VFG) has the combined advantages of mechanical strength and biological activity. The aims of this study were to investigate scintigraphic viability and radiographic union patterns of composite grafts after surgery, union rates, functional outcomes, and complication rates. METHODS: Seventeen patients underwent intercalary composite reconstruction using PTM and VFG (12 male, 2 female, mean age: 10.9 y). Retrospective evaluation of radiography and bone scintigraphy was performed. The most common diagnosis was osteosarcoma (12/14, 85.7%). All radiography and bone scintigraphy was reviewed for bone healing and tracer uptake semiquantitatively using the ratio of the reconstructed portion to the contralateral side. Complications and oncological and functional outcomes were recorded. RESULTS: At a mean follow-up of 33.1 months, primary union was achieved in all 28 host-graft junctions in all 14 patients. The respective mean times to proximal and distal junction bone union were 6.9 and 6.5 months. Metaphyseal junctions healed faster than diaphysis junctions (5.2 vs. 8.0 mo, P=0.02). Free fibular was integrated with surrounding bone after a mean of 10.1 months. The mean tracer uptake ratio was 1.1 after a mean of 4.8 months postoperatively. Half patients (50%) had higher uptake on bone scan than contralateral side. There was no significant correlation between uptake value and bone healing time. Five complications occurred in 4 patients (28.6%), and 1 patient (7.1%) contracted an infection. No fractures or breakages were observed. The mean Musculoskeletal Tumor Society 93 score was 87.6%. CONCLUSIONS: Reconstruction using PTM combined with VFG is associated with good short-term biological activity as indicated by bone scintigraphy, a high union rate, and an acceptable complication rate. The technique is a useful reconstruction option for large segmental bone defects after tumor resection in lower extremities. LEVEL OF EVIDENCE: Level IV-therapeutic study.

[Effectiveness of free vascularized fibular graft for bone defect after resection of lower limb malignant tumor].

OBJECTIVE: To analyze the effectiveness of free vascularized fibula grafts (FVFG) for extensive bone defects after resection of lower limb malignant bone tumors. METHODS: Between November 2015 and July 2018, 15 cases of lower limb malignant bone tumors were treated. There were 12 males and 3 females with an average age of 12.3 years (range, 9-21 years). There were 11 cases of osteosarcoma and 4 cases of Ewing's sarcoma. The tumor located at middle femur in 8 cases, lower femur in 4 cases, and middle tibia in 3 cases. The disease duration was 2-6 months (mean, 3.2 months). The tumor was completely removed, and the length of the bone defect was 8-23 cm (mean, 17.7 cm). The bone defect was repaired by FVFG, and combined inactivated tumor bone was used in 8 cases of femoral bone defect. RESULTS: The average operation time was 280 minutes (range, 180-390 minutes). The average blood loss was 310 mL (range, 200-480 mL). All incisions healed by first intention. All patients were followed up 2-24 months with an average of 14.5 months. Bone healing achieved in all patients at 9-18 months (mean, 12.3 months) after operation except 1 patient which was followed up only 2 months. The fibula grafts had active metabolism and the average bone metabolism score was 184 (range, 111-257) in effected side and 193 (range, 127-259) in contralateral side. There was no difference between bilateral sides. The average Enneking score was 24.6 (range, 20-30) at last follow-up. No ankle instability or paralysis of common peroneal nerve occurred. CONCLUSION: FVFG appeared very efficient in repair of extensive bone defect after resection of lower limb malignant bone tumor.

Analysis of the risk factors for influenza A (H1N1) pneumonia.

Pneumonia is the most common complication of influenza A (H1N1). However, there has been no identification of any single initial symptom as an independent risk factor. In 2009, 206 patients were diagnosed with H1N1 in the Chengde area, China and they were assembled in the Chengde Hospital for Infectious Diseases. The diagnosis and treatment were performed in accordance with the Protocol for Diagnosis and Treatment of Influenza A (H1N1) (2009, third edition), issued by the General Office of the Ministry of Health, with detailed records by the medical staff assigned by the Bureau of Health of the Chengde government. All the patients had viral nucleic acid-positive throat swabs detected with quantitative reverse transcription polymerase chain reaction (qPCR). Based on the final imaging findings, patients were divided into the pneumonia and non-pneumonia groups for this case control study. The univariate analysis demonstrated that the ratios of patients aged 0-5 and ≥45 years, with underlying diseases, with initial symptoms including cough, expectoration and dyspnea and with onset-to-treatment interval of >48 h were higher in the pneumonia compared to the non-pneumonia group (P<0.001, P<0.001, P=0.018, P<0.001, P<0.001 and P<0.001, respectively). The multivariate logistic regression analysis demonstrated that age 0-5 years, presence of underlying diseases, expectoration as the initial symptom and onset-to-treatment interval of >48 h were the independent risk factors for pneumonia with relative odds ratios (OR) and 95% confidence intervals (95% CIs) of 6.120 and 1.779-21.088, 11.188 and 2.021-61.935, 5.263 and 2.042-13.562, and 22.873 and 6.110-85.631, respectively (P<0.01). Therefore, it is recommended that patients with H1N1 presenting with expectoration as the initial symptom be treated with caution during influenza pandemics.

[Radial artery recurrent branch of styloid process bone flap transfer for treatment of scaphoid nonunion].

OBJECTIVE: To investigate the clinical efficacy of radial artery recurrent branch of the styloid process bone flap transfer for treatment of scaphoid nonunion. METHODS: From 2002 to 2007, 18 patients with scaphoid nonunion included 12 males and 16 females with an average age of 31.2 years old ranging from l8 to 51 years. Time from injury to operation was 8 to 26 months (averaged 12.5 months). Radial bone flap blood supply by radial artery recurrent branch of styloid process was embedded in retrograde scaphoid shift distance at both ends, Kirschner wire fixed on the bone flap and bone fractures, and the radial styloid process was resected. Cast gypsum immobilization in a neutral place of wrist were performed for 6 to 8 weeks, the rehabilitation of physical therapy and functional exercise were performed after removal. Kirschner wire were removed after X-ray showed fracture healing. RESULTS: Among them, 15 cases were followed-up for from 8 to 25 months (means 13 months). All fractures healed. The healing time was 8 to 12 weeks. According to adult forearm fracture evaluation of Anderson the results were excellent in 14 cases, good in 1. CONCLUSION: The radial artery recurrent branch of styloid process bone flap has a wealth of blood circulation, can make free grafting of the creeping substitution process directly into the healing process.

[A study of the prevalence of obstructive sleep apnea hypopnea syndrome in drivers].

OBJECTIVE: To study the prevalence of snoring and obstructive sleep apnea hypopnea syndrome (OSAHS) in drivers in Chengde city. METHODS: The prevalence of snoring and OSAHS in drivers was investigated by a questionnaire, and some of the drivers with more severe snoring were also evaluated by polysomnographic study. RESULTS: Among the 718 investigated drivers, never snoring was reported in 68.3% (490/718), mild snoring in 31.7% (228/718), and moderate and severe snoring in 16.6% (119/718). The prevalence of snoring increased with age. The prevalence of snoring was higher in males (33.6%) than in females (15.3%). When their knowledge of snoring was evaluated, 43.2% (310/718) thought snoring was not a disease, 16.7% (120/718) considered snoring as a disease but needed no treatment, 40.1% (228/718) considered it as a disease and needed treatment but only 1 had ever received treatment. If AHI > or = 5/h was used as the diagnostic criteria, the prevalence of OSAHS in the drivers was 12.3% (28/228); and if Epworth Sleepiness Scoring (ESS > or = 9) was combined, the prevalence of OSAHS was 4.1% (9/228). CONCLUSION: The prevalence of snoring in drivers was 31.7%, and the prevalence of OSAHS was 4.1%. Drivers need to be informed of the potential harm of OSAHS on their work.

[Epidemiologic study on the relationship between smoking and sleep apnea/hypopnea syndrome].

OBJECTIVE: To investigate how smoking was affecting the prevalence of sleep apnea/ hypopnea syndrome (SAHS) among adults aged over 30 years in Chengde city of Hebei province. METHODS: 1168 subjects, over 30 years of age were derived from a random sample from a community-based population in Shuangqiao district of Chengde city. All subjects responded to a questionnaire at their own houses regarding their habits of snoring and smoking. 1168 subjects (95.2%) answered the questions satisfactorily. RESULTS: (1) Among the smoking groups, the prevalence of snoring was 69.09%, higher than that in the nonsmoking groups 45.07% (P = 0.000). (2) In males, the smoking group had a higher prevalence (69.72%) of snoring than in the nonsmoking group (60.80%, P = 0.033). (3) Females in the smoking group had a higher prevalence of snoring (61.80%) than in the nonsmoking group (39.70%, P = 0.011). (4) The prevalence of snoring in males (60.80%) was significantly higher than that in females (39.70%, P = 0.000). (5) The prevalence (69.72%) of snoring in smoking males was similar to that in smoking females (61.80%, P = 0.336). (6) Data from logistic regression analysis indicated that smoking was one of the factors affecting snoring. (7) According to the degree of snoring, 127 moderate and severe snorers were measured by portable PSG for a whole night and the prevalence of SAHS was estimated. According to the AHI > or = 5 and the ESS > or = 9 cutoff-points, the prevalence rates of SAHS in smoking groups were both significantly higher than that in nonsmoking groups (P < 0.001). CONCLUSION: Smoking and snoring among adults aged over 30 years had correlation in our city.