Improved cure rate of periprosthetic joint infection through targeted antibiotic therapy based on integrated pathogen diagnosis strategy.

Objectives: This study aimed to determine whether combined of pathogen detection strategies, including specimen acquisition, culture conditions, and molecular diagnostics, can improve treatment outcomes in patients with periprosthetic joint infections (PJI). Methods: This retrospective study included suspected PJI cases from three sequential stages at our institution: Stage A (July 2012 to June 2015), Stage B (July 2015 to June 2018), and Stage C (July 2018 to June 2021). Cases were categorized into PJI and aseptic failure (AF) groups based on European Bone and Joint Infection Society (EBJIS) criteria. Utilization of pathogen diagnostic strategies, pathogen detection rates, targeted antibiotic prescription rates, and treatment outcomes were analyzed and compared across the three stages. Results: A total of 165 PJI cases and 38 AF cases were included in this study. With the progressive implementation of the three optimization approaches across stages A, B and C, pathogen detection rates exhibited a gradual increase (χ2 = 8.282, P=0.016). Similarly, utilization of targeted antibiotic therapy increased stepwise from 57.1% in Stage A, to 82.3% in Stage B, and to 84% in Stage C (χ2 = 9.515, P=0.009). The 2-year infection control rate exceeded 90% in both stages B and C, surpassing stage A (71.4%) (χ2 = 8.317, P=0.011). Combined application of all three optimized protocols yielded the highest sensitivity of 91.21% for pathogen detection, while retaining higher specificity of 92.11%. Conclusion: The utilization of combined pathogen diagnostic strategies in PJI can increase pathogen detection rates, improve targeted antibiotic prescription, reduce the occurrence of antibiotic complications, and achieve better treatment outcomes.

[Application of new H-shaped anatomical titanium plate for posterior wall/posterior column acetabular fractures].

OBJECTIVE: To explore the effectiveness of a new H-shaped anatomical titanium plate in treatment of posterior wall/posterior column acetabular fractures. METHODS: Between March 2012 and April 2019, 46 patients with acetabular fractures involving posterior wall/posterior column were treated with the new H-shaped anatomical titanium plates. There were 28 males and 18 females. The age ranged from 20 to 70 years, with an average of 45.5 years. Among the patients, 34 cases were injured by traffic accidents and 12 cases by falling from height. The time from injury to operation ranged from 2 to 14 days, with an average of 7 days. According to Letournel-Judet classification, there were 12 cases of posterior wall fractures, 1 case of posterior column fracture, 3 cases of transverse fractures, 9 cases of transverse fractures involving posterior walls, 8 cases of posterior column and posterior wall fractures, 2 cases of anterior column and posterior semi-transverse fractures, 3 cases of T-shaped fractures, and 8 cases of double column fractures. Matta reduction standard was used to evaluate fracture reduction and Merle d'Aubign-Postel score was used to evaluate hip joint function. RESULTS: All operations were successfully completed. The time of posterior operation was 60-120 minutes, with an average of 80 minutes. The amount of intraoperative blood loss ranged from 200 to 600 mL, with an average of 300 mL. All the incisions healed by first intention and no infection, deep vein thrombosis, or sciatic nerve injury occurred. All 46 patients were followed up 6-72 months, with an average of 37 months. According to Matta reduction standard, 40 cases obtained anatomic reduction, 4 cases satisfactory reduction, 2 cases unsatisfactory reduction, and the satisfaction rate was 95.7% (44/46). All fractures healed, and the healing time was 3-6 months, with an average of 4.3 months. No internal fixation failure occurred during the follow-up. At last follow-up, the Merle d'Aubign-Postel score ranged from 6 to 18 (mean, 15.5), including 38 cases of excellent, 4 cases of good, 2 cases of fair, and 2 cases of poor, with an excellent and good rate of 91.3% (42/46). Heterotopic ossification occurred in 4 cases, traumatic arthritis in 4 cases, and osteonecrosis of femoral head in 2 cases after operation. CONCLUSION: For acetabular fractures involving posterior wall/posterior column, the new H-shaped anatomical titanium plate can provide stable fixation, satisfactory reduction, and good recovery of hip function.

Green Production of Regenerated Cellulose/Boron Nitride Nanosheet Textiles for Static and Dynamic Personal Cooling.

Personal cooling technology using functional clothing that could provide localized thermal regulation instead of cooling the entire space is regarded as a highly anticipated strategy to not only facilitate thermal comfort and human health but also be energy-saving and low-cost. The challenge is how to endow textiles with prominent cooling effect whenever the wearer is motionless or sportive. In this study, high content of edge-selective hydroxylated boron nitride nanosheets (BNNSs) up to 60 wt % was added into a biodegradable cellulose/alkaline/urea aqueous solution, and then regenerated cellulose (RCF)/BNNS multifilaments were successfully spun in a simple, low-cost, and environmentally friendly process, which was demonstrated to serve as both static and dynamic personal cooling textile. Typically, excellent axial thermal conductivity of RCF/BNNS filament rendered that body-generated heat could directly escape from skin to the outside surface of the textile by means of thermal conduction, achieving a much better static personal cooling result through continuous thermal radiation. Besides, synergistic effect between excellent heat dissipation capability and good hygroscopicity also resulted in much better dynamic cooling effect once the wearer is doing some sports, whose efficiency was even better than commercial hygroscopic textiles such as cotton and RCF.

IRF1 Negatively Regulates Oncogenic KPNA2 Expression Under Growth Stimulation and Hypoxia in Lung Cancer Cells.

PURPOSE: Karyopherin alpha 2 (KPNA2) has been reported as an oncogenic protein in numerous human cancers and is currently considered a potential therapeutic target. However, the transcriptional regulation and physiological conditions underlying KPNA2 expression remain unclear. The aim of the present study was to investigate the role and regulation of interferon regulatory factor-1 (IRF1) in modulating KPNA2 expression in lung adenocarcinoma (ADC). MATERIALS AND METHODS: Bioinformatics tools and chromatin immunoprecipitation were used to analyze the transcription factor (TF) binding sites in the KPNA2 promoter region. We searched for a potential role of IRF1 in non-small-cell lung cancer (NSCLC) using Oncomine and Kaplan-Meier Plotter datasets. qRT-PCR was applied to examine the role of IRF1 and signaling involved in regulating KPNA2 transcription. Western blotting was used to determine the effects of extracellular stimulation and intracellular signaling on the modulation of KPNA2-related TF expression. RESULTS: IRF1 was identified as a novel TF that suppresses KPNA2 gene expression. We observed that IRF1 expression was lower in cancerous tissues than in normal lung tissues and that its low expression was correlated with poor prognosis in NSCLC. Notably, both ataxia telangiectasia mutated (ATM) and mechanistic target of rapamycin (mTOR) inhibitors reduced KPNA2 expression, which was accompanied by increased expression of IRF1 but decreased expression of E2F1, a TF that promotes KPNA2 expression in lung ADC cells. IRF1 knockdown restored the reduced levels of KPNA2 in ATM inhibitor-treated cells. We further demonstrated that epidermal growth factor (EGF)-activated mTOR and hypoxia-induced ATM suppressed IRF1 expression but promoted E2F1 expression, which in turn upregulated KPNA2 expression in lung ADC cells. CONCLUSION: IRF1 acts as a potential tumor suppressor in NSCLC. EGF and hypoxia promote KPNA2 expression by simultaneously suppressing IRF1 expression and enhancing E2F1 expression in lung ADC cells. Our study provides new insights into targeted therapy for lung cancer.

Can we predict the outcome of 595-nm wavelength pulsed dye laser therapy on capillary vascular malformations from the first beginning: a pilot study of efficacy co-related factors in 686 Chinese patients.

Currently, there are no standardized, objective, and clinically applicable methods to predict the outcome of pulsed dye laser (PDL) therapy on capillary vascular malformation (CVM) patients. The introduction of a method that can predict the outcome prior to treatment will be valuable for both the patients and the doctors. In this study, the authors treated CVM with 595-nm wavelength PDL in Chinese patients (n = 686) and analyzed the efficacy of treatment and complications retrospectively in a 5-year period. Nearly 18 % of patients (n = 122) had 76 % or more clearing of lesions; over 52 % of patients (n = 360) had more than 50 % of clearing. The lesions in head and neck region had the best effective rate (58.3 %), followed by trunk (42.9 %) and extremities (35.6 %). The efficacy of PDL therapy is related to age, type, and location of lesions. Fifty-seven patients (8.3 %) had complications, including 2.0 % blistering (n = 14), 4.5 % hyperpigmentation (n = 31), 1.3 % hypopigmentation (n = 9), and 0.4 % hypertrophic scarring (n = 3). Based on these preliminary data, the authors established a standardized, objective, and clinically applicable equation that may be applied to predict the efficacy of 595 nm PDL therapy on a newly diagnosed Chinese CVM patients based on the age, type, and location of lesions.

[Contrast-enhanced ultrasound findings of breast cancer].

OBJECTIVE: To study the manifestation of breast cancers of different sizes in contrast-enhanced sonography. METHODS: Eighty-four patients with breast cancers were examined by contrast-enhanced ultrasound. Among them, the tumor diameter was beyond 2.0 cm in 50 cases, and no greater than 2.0 cm in the rest cases. The time-intensity curve (TIC) on the enhanced images was analyzed quantitatively, and the relations between the type of TIC and the enhancement patterns of the tumors were analyzed. RESULTS: The enhancement patterns of the breast cancers showed significant difference between patients with tumor diameter beyond 2.0 cm and those with smaller tumors (P<0.01), but the other parameters were comparable between the two groups (P>0.05). CONCLUSION: The enhancement patterns of breast cancers differ between tumors with sizes over 2.0 cm and smaller tumors, and differential analysis is suggested in the diagnosis of breast cancer using contrast-enhanced ultrasound.