LncRNA H19 Regulates Lipopolysaccharide (LPS)-Induced Apoptosis and Inflammation of BV2 Microglia Cells Through Targeting miR-325-3p/NEUROD4 Axis.

Spinal cord injury (SCI) is a devastating traumatic event worldwide. Work from the past decade has highlighted the key involvement of long non-coding RNAs (lncRNAs) in SCI. Nevertheless, the molecular action of lncRNA H19 in SCI is still not fully understood. The levels of H19, microRNA (miR)-325-3p, and neuronal differentiation 4 (NEUROD4) were determined by quantitative real-time polymerase chain reaction (qRT-PCR) or western blot. Flow cytometry was performed to assess cell apoptosis. The levels of tumor necrosis factor-α (TNF-α), interleukin 1ß (IL-1ß), and IL-6 were detected using the enzyme-linked immunosorbent assay (ELISA). Targeted relationships among H19, miR-325-3p, and NEUROD4 were confirmed by dual-luciferase reporter, RNA immunoprecipitation (RIP), or RNA pull-down assays. Our data showed that H19 level was overexpressed in lipopolysaccharide (LPS)-treated BV2 cells. H19 silencing alleviated LPS-evoked cell apoptosis and inflammation. Mechanistically, H19 in BV2 cells directly targeted miR-325-3p, and NEUROD4 was a direct target of miR-325-3p. Moreover, miR-325-3p was a functional target of H19 in regulating cell apoptosis and inflammation induced by LPS. Enforced expression of miR-325-3p relieved LPS-evoked cell apoptosis and inflammation through reducing NEUROD4. Furthermore, H19 in BV2 cells regulated NEUROD4 expression through targeting miR-325-3p. Our results identified that the silencing of H19 attenuated LPS-evoked microglia cell apoptosis and inflammation after SCI at least partially through targeting the miR-325-3p/NEUROD4 axis, highlighting a novel approach for SCI management.

[Value of detecting bacterial 16S and 23S rRNA in interface membrane in diagnosis of periprosthetic joint infection].

OBJECTIVE: To explore the value of detecting bacterial 16S rRNA with 23S rRNA in the diagnosis of periprosthetic joint infection (PJI). METHODS: A prospective study was conducted among 67 patients with previous total hip arthroplasty (THA) undergoing a reoperation for infection (23 patients) or aseptic loosening (44 patients). Bacterial 16S rRNA and 23S rRNA in the interface membrane were detected by real-time PCR and their value in diagnosis of PJI was assessed. RESULTS: The 16S rRNA and 23S rRNA showed no significant difference in their power in the diagnosis of PJI. The detection of 16S rRNA/23S rRNA showed a higher sensitivity and a greater negative predictive value in PJI diagnosis than the detection of 16S rRNA+23S rRNA (95.7% vs 52.2%, P<0.01; 97.6% vs 79.6%, P=0.01). The specificity, positive predictive value, and accuracy of the 4 diagnostic strategies were not significantly different. CONCLUSIONS: The diagnostic power of 16S rRNA and 23S rRNA was similar in detecting PJI. Compared with the diagnostic strategy with 16S rRNA+23S rRNA, 16S rRNA/23S rRNA is more sensitive in detecting PJI.

Greater trochanter osteotomy with cementless THA for Crowe type IV DDH.

This study explored the surgical method and short-term clinical effect of a greater trochanter osteotomy along with cementless artificial total hip arthroplasty in the treatment of Crowe type IV developmental dysplasia of the hip. The authors conducted a retrospective analysis of 18 patients (22 hips) with Crowe type IV dysplasia who were seen between June 2008 and August 2010. After undergoing cementless artificial total hip arthroplasty using a posterolateral approach, a greater trochanter osteotomy was used to adjust the tension of the gluteal muscle, and an acetabular cup was placed. Average preoperative length shortening of the affected limb was 4.5 cm (range, 3.4-6 cm), and average postoperative length increase was 4.0 cm (range, 3.2-4.8 cm). Average postoperative Harris Hip Score was 87 (range, 79-91), which was higher than the average preoperative score of 38 (range, 32-51). Intraoperatively, 3 hips (3 patients) sustained a proximal femur fracture. Due to the stability of the femoral prosthesis, either no treatment or wire fixation only was given; by 2 months postoperatively, radiographs indicated that all fractures had healed. One patient had symptoms of sciatic nerve paralysis that resolved 3 months postoperatively. Performing a greater trochanter osteotomy after cementless artificial total hip arthroplasty is effective for the treatment of Crowe type IV dysplasia and can rebuild the complex biology and biomechanics of hip dysplasia without increasing the complication risk.

[Two-stage revision of infected total knee arthroplasty using antibiotic-impregnated articulating cement spacer].

OBJECTIVE: To investigate the effectiveness of two-stage revision of infected total knee arthroplasty (TKA) using an antibiotic-impregnated articulating cement spacer. METHODS: The clinical data were analyzed from 23 patients (23 knees) undergoing two-stage revision for late infection after primary TKA between January 2007 and December 2009. There were 15 males and 8 females, aged from 43 to 75 years (mean, 65.2 years). Infection occurred at 13-52 months (mean, 17.3 months) after TKA. The time interval between infection and admission ranged from 15 days to 7 months (mean, 2.1 months). One-stage operation included surgical debridement and removal of all knee prosthesis and cement, then an antibiotic-impregnated articulating cement spacer was implanted. The re-implantation of prosthesis was performed after 8-10 weeks when infections were controlled. The American Hospital for Special Surgery (HSS) score and Knee Society Score (KSS) were used to compare the function of the knee between pre- and post-revision. The rate of infection control and complication were analyzed. RESULTS: All incisions healed primarily. Re-infection occurred in 2 cases after two-stage revision, and infection was controlled in the other 21 cases, with an infection control rate of 91.3%. The patients were followed up 2-5 years (mean, 3.6 years). The HSS score was increased from 60.6 +/- 9.8 at pre-revision to 82.3 +/- 7.4 at last follow-up, the KSS score was increased from 110.7 +/- 9.6 at pre-revision to 134.0 +/- 10.5 at last follow-up, all showing significant differences (P < 0.01). Radiographs showed that prosthesis had good position with no loosening, fracture, or periprosthetic radiolucent. CONCLUSION: Two-stage revision using an antibiotic-impregnated articulating cement spacer is an effective method to control infected TKA and to restore the function of affected knee.

Large-diameter Delta ceramic-on-ceramic versus common-sized ceramic-on-polyethylene bearings in THA.

The higher failure rate of total hip arthroplasty (THA) in young, active patients remains a challenge for surgeons. Recently, larger-diameter femoral heads combined with an alumina matrix composite ceramic (BIOLOX Delta; CeramTec AG, Plochingen, Germany) articulation was developed to improve implant longevity and meet patients' activity demands while reducing the risk of component-related complications. The purpose of this study was to determine whether this new device may provide advantages for young, active patients. A prospective, randomized, controlled trial was conducted on 93 patients (113 THAs) with more than 3 years of follow-up. Patients were randomly divided into a study group (51 THAs) with a 36-mm Delta ceramic-on-ceramic (COC) articulation and a control group (62 THAs) with a common-sized alumina ceramic head on polyethylene liner (COP) articulation. Clinical and radiographic results were collected to compare the outcomes and complications, including implant-related failures, osteolysis, and noises. The large-diameter Delta COC articulation provided greater range of motion improvement (6.1° more), similar Harris Hip Scores, and similar complication rates compared with the alumina COP articulation. This study suggests that in the short term, the large-diameter Delta COC articulation results in better range of motion with no higher complication rates; however, mid-term (8-10 years) or longer follow-up is necessary to determine its superiority in young, active patients.

[Correlation between C-reactive protein and pain in periprosthetic infection after total hip arthroplasty].

OBJECTIVE: To explore the difference in level of pain experienced by patients with total hip arthroplasty between aseptic loosening and periprosthetic infection, and to examine the correlation between C-reactive protein (CRP) and pain. METHODS: Fifty-one patients (recruited from our hospital between March 2010 and November 2011) suffering aseptic loosening or periprosthetic infection after total hip arthroplasty were included in this study: 24 males and 27 females, with mean age 68.13 years. The patients were divided into an aseptic loosening group (n=31) and a periprosthetic infection group (n=20). Both the visual analog scale (VAS) and Harris pain score were used to estimate the level of pain experienced by the patients. CRP levels in serum were measured. The difference in assessment of pain by VAS and Harris pain score was compared between the two groups, and the correlation between pain and CRP was analyzed. RESULTS: The mean VAS in the aseptic loosening group was 5.39 (2.10-8.13) compared with 5.48 (2.09-8.30) in the periprosthetic infection group; however, the difference was not statistically significant (P=0.85). The mean rank of Harris pain score was 26.23 in the aseptic loosening group and 25.65 in the periprosthetic infection group, but again there was no significant difference (P=0.88). The CRP level in the periprosthetic infection group (36.20-101.40 mg/L, mean 72.86 mg/L) was obvious higher than that in the aseptic loosening group (1.37-13.70 mg/L, mean 6.53 mg/L), and the difference was statistically significant (P<0.01). The VAS was related with the CRP level in the periprosthetic infection group (r=0.87, P<0.01), and the correlation between Harris pain score and CRP level was conspicuous (r=0.92, P<0.01) in this group. However, those correlations were not evident in the aseptic loosening group (r=0.25, P=0.17; r=0.19, P=0.65). CONCLUSION: There is no difference in perception of pain in patients after total hip arthroplasty between those with aseptic loosening and those with periprosthetic infection. It is therefore unreliable to make a initial diagnosis only according to the level of pain. However, the level of CRP is a sensitive and effective way of differentiating the two conditions. The positive correlation between CRP and pian exists in patients with periprosthetic infection but not with aseptic loosening.

[Reason analysis and treatment of acetabular component initial instability after primary total hip arthroplasty].

OBJECTIVE: To analyze the main reasons of acetabular component initial instability after primary total hip arthroplasty (THA) and to discuss the prevention and management. METHODS: The clinical data were retrospectively analyzed from 19 patients undergoing revision for acetabular component initial instability after primary THA between January 2003 and June 2010. There were 11 males and 8 females, aged from 55 to 79 years (mean, 67.2 years). The locations were left hip in 9 cases and right hip in 10 cases. The cementless hip prosthesis was used in 12 cases and cement hip prosthesis in 7 cases. The revisions were performed at 3 weeks to 6 months after primary THA. The reasons of early failure were analyzed. Both the coverage rate of acetabulum-bone and the Harris hip score were compared between pre- and post-revision. RESULTS: The main reason of acetabular component initial instability after primary THA may be unsuitable treatment of acetabulum, improper selection of acetabular component, and incorrect place angle of acetabular component. Sciatic nerve palsy occurred in 1 case and recovered at 7 weeks after revision. Slight fracture of the acetabulum in 1 case and healed at 3 months after revision. All incisions healed by first intention. No infection, vessel injury, displacement of acetabular component, or deep vein thrombosis occurred. The patients were followed up 11-73 months (mean, 28 months). At last follow-up, no acetabular component instability was observed. The coverage rate of acetabulum-bone was increased from 67.9% +/- 5.5% before revision to 87.7% +/- 5.2% after revision, showing significant difference (t = 11.592, P = 0.003). The Harris hip score at last follow-up (84.4 +/- 4.6) was significantly higher than that at pre-revision (56.5 +/- 9.3) (t = 11.380, P = 0.005). CONCLUSION: Detailed surgical plan, proper choice of component, correct place angle and elaborative planning, and proficient surgical skill are necessary to achieve the initial stability of acetabular component in THA.