Prolonged efficacy of cefazolin in intraosseous regional prophylaxis for total knee arthroplasty: a rabbit model study.

BACKGROUND: A novel approach known as intraosseous regional administration (IORA) has emerged as a technique for delivering prophylactic antibiotics, and it results in higher tissue concentrations around the knee. It is hypothesized that IORA of cefazolin for antibiotic prophylaxis during total knee arthroplasty will result in sustained effective levels for a longer duration. The aim of the current study was to investigate temporal changes in peri-knee cefazolin blood concentrations after IORA of cefazolin. METHODS: Twelve rabbits were randomly divided into two groups, with six rabbits in each group. In control group a single intravenous bolus injection of cefazolin (10 mL, 100 mg) was administered into the marginal ear vein. In experimental groupexperimental group the same dose of cefazolin was injected into the left tibial marrow cavity after tourniquet inflation at the base of the left thigh. Blood samples were collected periodically at different timepoints, and cefazolin concentrations were determined. RESULTS: The intraosseous treatment resulted in significant differences in plasma cefazolin concentrations at all timepoints. Experimental group exhibited higher plasma cefazolin concentrations than control group. CONCLUSIONS: Cefazolin in intraosseous regional prophylaxis exhibits effectiveness in intraoperative antibiotic prophylaxis by maintaining concentrations above the minimum inhibitory concentration for extended durations, rather than relying solely on high concentrations.

Arthritis of the hip caused by arteriovenous malformations: A case report.

BACKGROUND Arthritis of the hip caused by arteriovenous malformations (AVMs) has been rarely reported. Therefore, total hip replacement (THR) in patients with AVM-induced arthritis of the hip is challenging. CASE SUMMARY We report a 44-year-old woman with aggravated right hip pain during the past decade. The patient presented with severe pain and a functional disorder of the right hip. X-ray examination revealed severely narrowed right hip joint space and abnormal trabecular bone loss in the femoral neck and trochanter area. Doppler ultrasound, magnetic resonance imaging and computed tomography angiography revealed AVMs surrounding the right hip, along with erosion. To ensure the safety of THR, we performed vascular embolization and temporary balloon occlusion of the iliac artery three times during the operation. However, serious hemorrhage occurred, which was rescued by the multimodality blood conservation strategy. THR was successfully performed, and the patient was discharged 8 d later for rehabilitation. Postoperative pathological examination showed osteonecrosis of the femoral head with malformed thick-walled vessels and focal granulomatous inflammation of the surrounding soft tissues. The Harris Hip Scale score increased from 31 to 82 at 3 mo of follow-up. The patient was followed up for 1 year, and all her clinical symptoms were significantly alleviated. CONCLUSION Arthritis of the hip caused by AVMs is rare in clinical practice. The activity and function of the involved hip joint can be effectively treated with THR after comprehensive imaging and multidisciplinary consultation.

A biphasic calcium phosphate/acylated methacrylate gelatin composite hydrogel promotes osteogenesis and bone repair.

PURPOSE/AIM: Bone defects caused by trauma, tumors, congenital malformation, or inflammation are very common in orthopedics. In recent years, mimicking the composition and structure of natural bone tissue has become a hot topic in biomaterial research, with the aim of developing an ideal biomaterial for bone defect transplantation. Here, the feasibility of a biphasic calcium phosphate (BCP)/acylated methacrylate gelatin (GelMA) composite hydrogel to repair bone defects was evaluated in vitro and in rats. MATERIALS AND METHODS: The biocompatibility of a biphasic calcium phosphate (BCP)/acylated methacrylate gelatin (GelMA) composite hydrogel was evaluated by cytoskeleton staining, live/dead cell staining and cell proliferation assays. The in vitro osteogenic activities of the composite hydrogel were evaluated by alkaline phosphatase and alizarin red staining, as well as osteogenic gene expression analysis at both transcript and protein levels. The in vivo bone repair activities were evaluated using the rat skull defect model. RESULTS: The BCP/GelMA composite hydrogel displayed excellent biocompatibility and promoted osteogenesis of bone marrow mesenchymal stem cells in vitro. In addition, the BCP/GelMA composite hydrogel markedly promoted new bone formation in the rat skull-defect model. CONCLUSIONS: BCP/GelMA composite hydrogel may be an effective artificial material for bone tissue engineering.

Heel pain caused by os subcalcis: A case report.

BACKGROUND: The accessory bones are common bone variations around the feet and ankles, which usually originate from nonunion of the secondary ossification center adjacent to the main bone mass, and most of them remain asymptomatic. Os subcalcis is an accessory bone at the plantar aspect of the calcaneus, which is located just posterior to the insertion of the plantar fascia. Focal bone formation at the calcaneal plantar pole with heel pain has rarely been reported. CASE SUMMARY: A 55-year-old man presented to our clinic with left plantar heel pain and a progressive swelling for 8 years. X-ray, computer tomography and magnetic resonance imaging showed a large os subcalcison the plantar side of the calcaneus, located at the insertion of the plantar fascia. He underwent surgical excision of the lesion. Microscopically the bony trabeculae were intermingled with fat and covered with cartilage. CONCLUSION: This is a rare case with accessory os subcalcis leading to heel pain. It highlights the awareness of os subcalcis and helps avoid future misdiagnosis of heel pain.

Comparison of Early Clinical Results for Femoral Neck System and Cannulated Screws in the Treatment of Unstable Femoral Neck Fractures.

OBJECTIVE: To compare early clinical effects of the femoral neck system (FNS) and three cannulated screws for the treatment of patients with unstable femoral neck fractures. METHODS: A retrospective analysis with pair matching of 81 patients who received FNS or cannulated screw internal fixation for Pauwels type-3 femoral neck fracture in our hospital from January 2019 to December 2019 was conducted. Patients who received FNS were the test group, and those who received cannulated screws comprised the control group. Matching requirements were as follows: same sex, similar age, and similar body mass index (BMI). A total of 30 pairs were successfully matched at a 1:1 ratio, including 12 males and 18 females. The average age of the patients in the FNS group was 54.53 ± 6.71 years. In the cannulated screw group, the average age of the patients was 53.14 ± 7.19 years. The operation time, intraoperative blood loss, hospital stay, hospitalization cost, postoperative visual analog scale (VAS) score, time to walking without crutches, Harris score, femoral head necrosis rate, and complication rate were compared between the groups. RESULTS: Postoperative re-examination of radiographs showed satisfactory reduction in all patients, and all patients were followed up for 10-22 months. Those in the FNS group had lower postoperative VAS scores, earlier times to walking without crutches, higher Harris scores at the last follow-up, and lower complication rates (P < 0.05). VAS scores were lower in the FNS group (3.13 ± 1.07 scores) than in the cannulated screw group (3.77 ± 1.04 scores) (P = 0.018). Patients in the FNS group (5.23 ± 1.33 months) recovered to walking without crutches earlier than did those in the cannulated screw group (6.03 ± 1.45 months) (P<0.001). In addition, a statistically higher postoperative Harris score was detected in the FNS group (86.16 ± 7.26) than in the cannulated screw group (82.37 ± 7.52) (P = 0.039). Overall, a higher incidence of complications was observed in the cannulated screw group (9/30) than in the FNS group (2/30) (P = 0.042). However, intraoperative blood loss and hospitalization costs were greater in the FNS group (P < 0.05). Intraoperative blood loss was greater in the FNS group (99.73 ± 4.69) than in the cannulated screw group (30.27 ± 9.04) (P<0.001). In addition, patients in the FNS group (46976 ± 2270 ¥) spent more on hospitalization costs than did those in the cannulated screw group (15626 ± 1732 ¥) (P<0.001). No statistically significant difference in operation time, hospital stay, or femoral head necrosis rate was observed between the two groups (P > 0.05). CONCLUSION: For patients with unstable femoral neck fractures, FNS has better clinical efficacy than cannulated screws, though it is also more expensive.

Neuroimaging findings of cerebral syphilitic gumma.

Cerebral syphilitic gumma is a rarely reported disease of the central nervous system. Magnetic resonance imaging (MRI) is an important diagnostic method for syphilitic gumma. The present study aimed to describe and characterize neuroimaging results from 6 patients with pathologically diagnosed cerebral syphilitic gumma. The 6 patients (age, 32-61 years) underwent brain CT and MRI, with 1 patient also undergoing whole-body 2-deoxy-2-(fluorine-18)fluoro-D-glucose-positron emission tomography/CT (18F-FDG PET/CT). Non-enhanced CT, conventional T1 weighted imaging (T1WI) and T2WI, diffusion weighted imaging (DWI) and gadolinium-enhanced T1WI images were acquired for all patients. The CT and MRI scans were retrospectively reviewed by two experienced radiologists for consensus on the location, number, size, T1WI, T2WI and DWI signal intensity characteristics, extent of vasogenic oedema, and enhancement patterns. In total, the 6 patients exhibited 10 lesions, nine of which were located in the cerebral hemisphere, primarily in the grey matter. The remaining lesion was located in the fourth ventricle, leading to mild-to-moderate hydrocephalus. The diameters of the identified 10 lesions ranged from 0.9-6.5 cm, with a mean diameter of 3.9 cm. The main feature observed in CT was low density and in MRI the features were T1WI and DWI hypointensity and T2WI hyperintensity. A single case exhibited syphilis gumma with massive haemorrhage. Ring-like or strip-like signs (n=5), accompanied by the dural tail sign (n=2) and homogeneous enhancement (n=1), were noted on T1WI with gadolinium. The 18F-FDG PET/CT performed in one patient of a cerebral syphilis gumma revealed low uptake and metabolism. The present study indicated that gadolinium-enhanced MRI combined with 18F-FDG PET/CT and laboratory examinations are helpful in distinguishing cerebral syphilitic gumma from brain tumors and infectious diseases, therefore avoiding unnecessary surgery.

Overexpression of microRNA-495 improves the intestinal mucosal barrier function by targeting STAT3 via inhibition of the JAK/STAT3 signaling pathway in a mouse model of ulcerative colitis.

We aim to investigate the role of microRNA-495 (miR-495) in the intestinal mucosal barrier by indirectly targeting signal transducer and activator of transcription 3 (STAT3) through the Janus kinase-signal transducer and activator of transcription (JAK)/STAT3 signaling pathway in a mouse model of ulcerative colitis (UC). BALB/c mice were selected for establishing mice model of UC, and intestinal tissues of normal and UC mice were collected. ELISA was conducted for detecting levels of TNF-α, IL-6, IFN-γ and IL-10. The levels of SOD, MPO, MDA and NO were tested in the intestinal tissues. Dual luciferase reporter gene assay was applied to determine whether miR-495 directly targets STAT3. Cells were cultured, transfected and assigned into: normal group, blank group, NC group, miR-495 mimic group, miR-495 inhibitor group, siRNA-STAT3 group and miR-495 inhibitor+siRNA-STAT3 group. MTT was used for testing cell proliferation, flow cytometry for cell cycle and apoptosis. Northern blotting and Western blotting were performed to detect miR-495 expression and expressions of STAT3, JAK and Claudin-1. Results show that the UC group had higher expression levels of TNF-α, IL-6, IFN-γ, MPO, MDA, NO, STAT3 and JAK and lower expression levels of IL-10, SOD, miR-495 and Claudin-1, compared to the normal group. Dual luciferase reporter gene assay confirmed that STAT3 was the target gene of miR-495. The miR-495 mimic and siRNA-STAT3 groups had higher expressions of Claudin-1, higher cell proliferation and increased amount of cells in S phase, but lower expressions of STAT3 and JAK, decreased amount of cells in G0/G1 phase and cell apoptotic rate compared with the blank, NC groups. We also found that the miR-495 inhibitor+siRNA-STAT3 group had reduced miR-495 expression. No significant differences were found in mRNA and protein expressions of STAT3, JAK and Claudin-1, cell proliferation, apoptosis and cycle amongst the miR-495 inhibitor+siRNA-STAT3 groups. Our study provides evidence that miR-495 improves the intestinal mucosal barrier function by targeting STAT3 through inhibiting the JAK/STAT3 signaling pathway in UC mice.

Diffusion-weighted magnetic resonance imaging for the detection of metastatic lymph nodes in patients with lung cancer: A meta-analysis.

The aim of the present meta-analysis was to evaluate the diagnostic value of diffusion-weighted imaging (DWI) in differentiating metastatic from non-metastatic lymph nodes in patients with lung cancer. A systematic literature search was performed to identify eligible original studies. The quality of included studies was assessed using 'quality assessment of diagnostic accuracy studies' (QUADAS-2). Meta-analysis was performed to pool sensitivity and specificity, to calculate the positive likelihood ratio (PLR), the negative likelihood ratio (NLR) and the diagnostic odds ratio (DOR), and to construct the summary receiver operating characteristic (SROC) curve. The homogeneity, threshold effect and publication bias were also investigated. Meta-regression analysis was performed to identify the sources of heterogeneity. A total of 10 studies with 11 datasets met the inclusion criteria, which comprised 796 patients with a total of 2,433 lymph nodes. The pooled diagnostic sensitivity was 0.78 [95% confidence interval (CI): 0.74-0.81] and the pooled diagnostic specificity was 0.88 (95% CI: 0.86-0.89). The PLR, NLR, and DOR were 7.11 (95% CI: 4.39-11.52), 0.24 (95% CI: 0.18-0.33), and 31.14 (95% CI: 17.32-55.98), respectively. The area under the SROC curve was 0.90. No publication bias was found (bias=-0.15, P=0.887). Notable heterogeneity was, however, observed, and patient selection, type of lung cancer, number of enrolled lymph nodes, reference standard, B-value and the type of scanner were the sources of heterogeneity (P<0.05). No significant threshold effect was identified (P=0.537). In conclusion, DWI has been revealed to be a valuable magnetic resonance imaging (MRI) modality, with good diagnostic performance for distinguishing metastatic from non-metastatic lymph nodes in patients with lung cancer. Therefore, DWI may be a useful supplement to conventional MRI techniques.

Evaluation of an in-vehicle monitoring system (IVMS) to reduce risky driving behaviors in commercial drivers: Comparison of in-cab warning lights and supervisory coaching with videos of driving behavior.

PROBLEM: Roadway incidents are the leading cause of work-related death in the United States. METHODS: The objective of this research was to evaluate whether two types of feedback from a commercially available in-vehicle monitoring system (IVMS) would reduce the incidence of risky driving behaviors in drivers from two companies. IVMS were installed in 315 vehicles representing the industries of local truck transportation and oil and gas support operations, and data were collected over an approximate two-year period in intervention and control groups. In one period, intervention group drivers were given feedback from in-cab warning lights from an IVMS that indicated occurrence of harsh vehicle maneuvers. In another period, intervention group drivers viewed video recordings of their risky driving behaviors with supervisors, and were coached by supervisors on safe driving practices. RESULTS: Risky driving behaviors declined significantly more during the period with coaching plus instant feedback with lights in comparison to the period with lights-only feedback (ORadj=0.61 95% CI 0.43-0.86; Holm-adjusted p=0.035) and the control group (ORadj=0.52 95% CI 0.33-0.82; Holm-adjusted p=0.032). Lights-only feedback was not found to be significantly different than the control group's decline from baseline (ORadj=0.86 95% CI 0.51-1.43; Holm-adjusted p>0.05). CONCLUSIONS: The largest decline in the rate of risky driving behaviors occurred when feedback included both supervisory coaching and lights. PRACTICAL APPLICATIONS: Supervisory coaching is an effective form of feedback to improve driving habits in the workplace. The potential advantages and limitations of this IVMS-based intervention program are discussed.

The influence of daily sleep patterns of commercial truck drivers on driving performance.

Fatigued and drowsy driving has been found to be a major cause of truck crashes. Lack of sleep is the number one cause of fatigue and drowsiness. However, there are limited data on the sleep patterns (sleep duration, sleep percentage in the duration of non-work period, and the time when sleep occurred) of truck drivers in non-work periods and the impact on driving performance. This paper examined sleep patterns of 96 commercial truck drivers during non-work periods and evaluated the influence these sleep patterns had on truck driving performance. Data were from the Naturalistic Truck Driving Study. Each driver participated in the study for approximately four weeks. A shift was defined as a non-work period followed by a work period. A total of 1397 shifts were identified. Four distinct sleep patterns were identified based on sleep duration, sleep start/end point in a non-work period, and the percentage of sleep with reference to the duration of non-work period. Driving performance was measured by safety-critical events, which included crashes, near-crashes, crash-relevant conflicts, and unintentional lane deviations. Negative binomial regression was used to evaluate the association between the sleep patterns and driving performance, adjusted for driver demographic information. The results showed that the sleep pattern with the highest safety-critical event rate was associated with shorter sleep, sleep in the early stage of a non-work period, and less sleep between 1 a.m. and 5 a.m. This study also found that male drivers, with fewer years of commercial vehicle driving experience and higher body mass index, were associated with deteriorated driving performance and increased driving risk. The results of this study could inform hours-of-service policy-making and benefit safety management in the trucking industry.

Angiomyolipoma of the rib: A rare case report.

Angiomyolipoma is a benign mesenchymal tumor, most commonly arising from the kidney. With the exception of the liver, extrarenal angiomyolipoma is an infrequent entity that may be misdiagnosed as other tumors. Angiomyolipoma occurring in the skeleton is an extremely rare occurrence and often difficult to differentiate from other bone diseases. We herein present a case of angiomyolipoma in the rib of a 44-year-old male patient, a highly unusual location for this type of tumor. Angiomyolipoma of the skeleton usually exhibits an infiltrative tendency. Although this clinical entity is rare, angiomyolipoma should be considered in the differential diagnosis of skeletal lesions, particularly in patients presenting with imaging findings of fat within the lesions.

A method of percutaneous vertebroplasty under the guidance of two C-arm fluoroscopes.

OBJECTIVE: To compare the clinical application in the percutaneous vertebroplasty under the guidance of one or two C-arm fluoroscopes. METHODS: One hundred forty three elderly patients with Osteoporotic vertebral compression fractures (OVCFs) underwent percutaneous vertebroplasty under the guidance of one or two C-arm fluoroscopes. The number of pulsed imagings, the time of operation and the incidence of cement leakage were recorded. RESULTS: The average number of pulsed imagings was 16.00±1.58 vs 13.07±2.00 per patient under the guidance of one vs two C-arm fluoroscopes. The average time of operation was 48.42±5.00 minutes vs 39.70±7.42 minutes per patient under the guidance of one vs two C-arm fluoroscopes. The incidence of cement leakage was 20% vs 15.7% of the patients under the guidance of one vs two C-arm fluoroscopes. The differences in the number of pulsed imagings and the time of operation were statistically significant. The difference in incidence of cement leakage was not statistically significant. CONCLUSION: The two-fluoroscopic technique reduce the labor cost, the radiation, the time of operation and the operation risk.

Heme oxygenase-1 promotes Caco-2 cell proliferation and migration by targeting CTNND1.

BACKGROUND: Heme oxygenase-1 (HO-1) can be induced by inflammatory cytokines, oxidation, ischemia, hypoxia, and endotoxins. As a "graft survival protective gene," HO-1 is a hot spot in organ transplantation research. However, the role of HO-1 gene expression in the function of human colon adenocarcinoma cell line (Caco-2) cells has not been reported previously. METHODS: The role of HO-1 in the proliferation and migration of Caco-2 cells was analyzed using a stable HO-1 expression plasmid. We constructed a recombinant adeno-associated virus plasmid containing the HO-1 gene, heme oxygenase 1 (HMOX1), which was transfected into Caco-2 intestinal cells. We identified a number of target genes by global microarray analysis combined with real-time polymerase chain reaction (PCR) and chromatin immunoprecipitation assay. RESULTS: Our results showed that significant HO-1 upregulation was demonstrated in the Caco-2 cells after HO-1 transfection. Restoration of HO-1 expression promoted proliferation and invasion in vitro. The CTNND1 gene, a member of the armadillo protein family, was identified as a direct HO-1 target gene. CONCLUSION: Overexpression of HO-1 promotes Caco-2 cell proliferation and migration by targeting the CTNND1 gene.

Bipolar hemiarthroplasty compared with internal fixation for unstable intertrochanteric fractures in elderly patients.

BACKGROUND: The optimal treatment for unstable intertrochanteric fractures in elderly patients remains controversial. We aimed to compare internal fixation and bipolar hemiarthroplasty for the treatment of unstable intertrochanteric fractures in elderly patients. METHODS: 124 patients aged over 70 years were enrolled into this study (64 internal fixations, 60 bipolar hemiarthroplasties). Patients were followed for two years, and had a clinical, radiological, and functional review at three, six, and twelve months as well as two years. RESULTS: In the internal fixation group, the fracture reduction and internal fixation were regarded as satisfactory in 44 cases and unsatisfactory in 20 cases. Five patients in the internal fixation group (two with satisfactory results and three with unsatisfactory results) and three patients in the arthroplasty group died before the final two-year follow-up. Five patients in the internal fixation group who had unsatisfactory results suffered complications. At 24 months post-operation, patients who were treated satisfactorily with internal fixation had higher Harris scores, less pain, and better walking ability than those treated with hemiarthroplasty and unsatisfactory internal fixation. CONCLUSIONS: Internal fixation with good reduction and fixation quality should be the preferred therapeutic method for elderly unstable intertrochanteric fractures, even when severe osteoporosis is present.

[Design and clinical application of new type two-head automatic pressure external fixation (TAPEF)].

OBJECTIVE: To design a new type two-head automatic pressure external fixator and explore its clinical effects in treating intertrochanteric fracture of the femur. METHODS: Base on unilateral angulated external fixator and Ilizarov techiques, a new type two-head automatic pressure external fixator were designed and made. From October 2006 to December 2010, 120 patients with intertrochanteric fracture of the femur were treated with the new type two-head automatic pressure external fixator. There were 67 males and 53 females with an average age of 76.7 years (ranged, 60 to 93 years). According to Evans classification, type I was in 65 cases, type II in 41, type III a in 10, type III b in 2 and type IV in 2. Operative time was from 0 to 11 days after injury with an average 5 days. Postoperative functional recovery was evaluated according to criteria of Sanders. RESULTS: Among 120 patients, 116 cases were followed up with an average of 12 months (ranged, 2 to 24 months). All fractures obtained healing with average healing time of 12 weeks (ranged, 10 to 13 weeks). Five cases occurred with superficial infection of pin site and no deep infection,non-union, coxa adducta were found. Joint function of hip recovered well. According to Sanders scoring, pain, walking, function, muscle strength, daily activities and X-ray estimate were respectively (9.07 +/- 0.41), (9.23 +/- 1.00), (9.42 +/- 1.10), (9.31 +/- 1.06), (9.22 +/- 1.03), (10.00 +/- 0.00) with total amount of (56.27 +/- 4.16). A hundred and six cases got an excellent results, 6 good, 4 poor. CONCLUSION: The new type two-head automatic pressure external fixator is easy and convenient to apply in operation. It has duplicate functions of load and minimal invasive. It is an ideal method for treatment of the intertrochanteric fracture of the femur in high-risk and senile patients.

Impact of federal compliance reviews of trucking companies in reducing highway truck crashes.

BACKGROUND: The compliance review (CR) is a federal program monitoring motor carrier safety performance and regulatory compliance. This study sought to assess the impact of CRs on reviewed trucking companies in reducing truck crashes. METHODS: Data was from the Motor Carrier Management Information System. Study subjects were trucking companies established during 1990-1995, had at least one truck, and remained active until April 2004. Truck crash data of these companies was examined from 1996 to 2003. The crash rates in 2003 and annual percentage changes in number of crashes were computed. Analyses were stratified by company size, organization, operation classification, and safety rating. RESULTS: Companies that received CRs had a higher crash rate than never-reviewed companies. Reviewed companies experienced a 39-15% reduction in number of crashes in the year the CR was performed. The reduction in crashes was observed in all reviewed companies regardless of company size, operation classification, type of organization, or safety rating. The reduction in crashes was sustained for at least 7 years after CRs. DISCUSSION: The study results were controlled for the year in which CRs were performed, crash trend, and CR selection bias. However, further studies, especially a randomized prospective longitudinal study, are needed to overcome the limitations that are associated with an observation study.