Blood eosinophilia and a higher ethmoid sinus/maxillary sinus score ratio predict new-onset asthma in patients with chronic rhinosinusitis with nasal polyps.

BACKGROUD: Presently, the impact of Chronic rhinosinusitis with nasal polyps (CRSwNP) on asthma onset is unknown. AIMS: To evaluate the role of CRSwNP in asthma onset. MATERIALS AND METHODS: A total of 3107 CRSwNP patients were retrospectively screened from 1 January 2018, to 31 May 2021; 624 patients were enrolled. Clinical data regarding nasal symptoms, Lund-Mackay scores, blood eosinophil percentage, and onset of asthma were analyzed. Patients were divided into different groups according to past history of nasal polyps, Lund-Mackay score, and the extent of blood eosinophilia. Asthma-free rates between these subgroups were analyzed by Kaplan-Meier curves and Cox regression models. RESULTS: The prevalence of asthma was 10.90% in patients with CRSwNP, and new-onset asthma occurred in 3.14% of these patients. Higher Lund-Mackay scores for ethmoid sinus and maxillary sinus (E/M) and blood eosinophil percentages were two independent risk factors for new-onset asthma, with hazard ratios of 1.267 (95%CI, 1.155-1.390) and 1.224 (95%CI, 1.054-1.422), respectively. CRSwNP patients with an E/M ratio > 2.33 or a blood Eos percentage > 5.5% were at risk for asthma onset. CONCLUSIONS AND SIGNIFICANCE: Blood eosinophilia and a higher E/M score ratio were associated with new-onset asthma in patients with CRSwNP.

Defect engineering modified bismuth vanadate toward efficient solar hydrogen peroxide production.

Industry for producing the vital chemical hydrogen peroxide (H2O2) requires drastically reductions in energy consumption and environmental pollution. Solar chemical conversion from O2 to H2O2 is considered to be the most promising alternative method, nevertheless, weak energy coupling between photo-charges and adsorbed species limits the yield of H2O2. Herein, we demonstrate that oxygen vacancy-rich BiVO4 can efficiently generate H2O2 in pure water under visible light irradiation without any heterojunctions or precious-metal cocatalysts. Oxygen vacancies, as typical coordinatively unsaturated sites, enable efficient O2 adsorption and enrichment, and then thriving chemisorption can spatially facilitate photoexcited electrons transfer to oxygen species. Compared to pristine BiVO4, defective BiVO4 enhanced O2 adsorption and interfacial electron transfer rate to O2 by 19 and 23 times, respectively, resulting in a more than 32-fold increase in H2O2 production. This research offers a new perspective for bridging solar and chemical energy by assuring species chemisorption.

Sepsis complicated with secondary hemophagocytic syndrome induced by giant gouty tophi rupture: A case report.

BACKGROUND: Gouty tophi are a chronic granulomatous caused by a deposition of monosodium urate crystal deposition in the body. Once broken, it may easily induce severe infection. Sepsis complicated with secondary hemophagocytic syndrome induced by gouty tophi rupture is extremely rare in the clinical setting, and no such serious complications have been reported in literature. CASE SUMMARY: This is a 52-year-old Chinese male patient with a 20-year history of gouty arthritis. At admission, the gout stone in the patient's right ankle was broken and it secreted a white mucoid substance. During the course of treatment, the patient suffered from systemic inflammatory response syndrome multiple times. His condition gradually deteriorated, further complicated by hemophagocytic syndrome. After thorough removal of gout lesions and active anti-infection treatment and control of blood uric acid level, combined with multidisciplinary cooperation, the patient was finally cured. CONCLUSION: Sepsis complicated with secondary hemophagocytic syndrome induced by gouty tophi rupture is extremely rare in the clinical setting. Timely and accurate diagnosis is very important to save patients' lives.

Synovial calprotectin for the diagnosis of periprosthetic joint infection: a diagnostic meta-analysis.

BACKGROUND: Periprosthetic joint infections (PJI) are a rare but severe complication of total joint arthroplasty (TJA). However, the diagnosis of PJI remains difficult. It is one of the research that focuses about diagnosis for PJI for majority researchers to discover a novel biomarker. This meta-analysis tried to evaluate diagnostic value of synovial calprotectin for PJI. METHODS: This meta-analysis search of the literature was conducted in PubMed, EMBASE, Web of Science, and the Cochrane Library. Literature quality was appraised using Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) based on RevMan (version 5.3). The diagnostic value of calprotectin for PJI was evaluated by calculating sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), diagnostic score and area under SROC (AUC) based on the Stata version 14.0 software. We conduct subgroup analysis according to the study design, cutoff values, the country of study, and gold standard. RESULTS: Seven studies were included in this meta-analysis. The pooled sensitivity of synovial calprotectin for the diagnosis of PJI was 0.94 (95% CI, 0.87-0.98), and the specificity was 0.93 (95% CI, 0.87-0.96). The pooled AUC, PLR, and NLR for synovial calprotectin were 0.98 (95% CI, 0.96-0.99), 13.65 (95% CI, 6.89-27.07), and 0.06 (95% CI, 0.02-0.15), respectively. The pooled diagnostic score and DOR were 5.4 (95% CI, 3.96-6.85) and 222.32 (95% CI, 52.52-941.12), respectively. CONCLUSION: In summary, this meta-analysis indicates that synovial calprotectin is a promising biomarker of assistant diagnosis for PJI, as well as recommended test for excluding diagnostic tool.

Acceptable outcomes with unicompartmental knee replacement and PCL deficiency are achievable: a case series of nine patients.

PURPOSE: Posterior cruciate ligament (PCL) deficiency is considered to be a contraindication for unicompartmental knee replacement (UKR); however, there is no evidence to support or contradict this. There are occasional circumstances where UKR in PCL deficient patients have been performed where the patient otherwise satisfies the indications for UKR. The aim of this paper is to describe the outcome of UKR in PCL deficient patients. METHODS: A retrospective study of patients with painful medial compartment osteoarthritis and PCL deficiency treated with Oxford UKR between 2006 and 2015 was undertaken. Clinical records from a prospectively recorded database were reviewed and outcomes were assessed based on revision rate, Oxford Knee Score (OKS), American Knee Society score and Tegner Activity Score. RESULTS: Nine patients were identified. The median age at surgery was 51 years (range 42-80) and median follow-up was 6 years (range 1-10). There was one bearing dislocation requiring open exchange. The outcome of seven patients was excellent (OKS > 41). Two patients, who were both elderly, had good outcomes (OKS 41 and 39). One patient had a poor outcome, but it is not clear if this was related to the knee as she had a learning disability and examination and radiographs of the knee were satisfactory. CONCLUSION: The results of this small series suggest that excellent results can be achieved with UKR for selected patients with medial osteoarthritis in a PCL deficient knee that was functioning well before the osteoarthritis developed. On the basis of this a larger study should be undertaken. Until more results are available PCL deficiency should be considered a relative contra-indication to UKR. LEVEL OF EVIDENCE: IV.

Differential expression of miR-195-5p in collapse of steroid-induced osteonecrosis of the femoral head.

BACKGROUND: Femoral head collapse is a key reference point for determining a treatment regimen of femoral head osteonecrosis. However, there are no effective preventive measures and the efficacy of hip-preserving surgery is unsatisfactory due to the unclear mechanism of collapse. This study aimed to identify and validate miRNAs differentially expressed in collapse and non-collapse areas of the osteonecrotic femoral head, and to predict the target genes and pathways of these miRNAs. RESULTS: Nine samples passed the quality control test. A total of 2085 differentially expressed miRNAs were detected, among which 433 miRNAs showed differential expression in the T1 group compared to the W1 group; 344 miRNAs showed differential expression in the T2 group compared to the W2 group; 107 miRNAs showed differential expression in the T3 group compared to the W3 group. After combining data from all three patients, 10 miRNAs showed differential expression in the collapse area (T1+T2+T3) compared to the non-collapse area (W1+W2+W3). Compared to the normal area, has-miR-195-5p showed the most significant downregulation. Expression results from RT-PCR revealed that the expression of hsa-miR-195-5p in the collapse area (T1+T2+T3) was significantly lower than that in the non-collapse area (W1+W2+W3) and normal area (Z1+Z2+Z3). 157 genes were perdicted as the target gene of hsa-miR-195-5p. MATERIALS AND METHODS: Femoral heads of three patients (2 males and 1 female) treated by total hip arthroplasty surgery for steroid-induced femoral head osteonecrosis were selected based on inclusion and exclusion criteria. Bone tissue samples were obtained from the collapse area (T), non-collapse area (W), and normal area (Z) according to the anatomical structure of osteonecrotic femoral heads. Total RNA was extracted from the samples and the microarray chip was scanned. miRNAs showing differential expressions of more than 1.5-fold were selected and was validated by RT-PCR. TargetScan, mirBase and miRanda bioinformatics software was used to predict target genes and identify possible pathways involving these genes. CONCLUSIONS: miR-195-5p showed the most significant difference in the collapse area of osteonecrotic femoral heads, suggesting that collapse may be related to the downregulation of miR-195-5p.

Does serum calcium relate to different types of hip fracture? A retrospective study.

PURPOSE: To investigate the potential correlation between two different types of hip fractures and serum calcium levels. METHODS: We consecutively studied 101 cases of femoral neck fracture and 95 cases of femoral inter- trochanteric fracture between January 2011 and December 2013. Fasting blood samples were taken and serum calcium measurements were performed respectively in three periods: the time of admission, postoperation, and discharge. Creatinine, alkaline phosphatase and albumin were also analyzed. RESULTS: Considering the levels of serum calcium between two groups at the time of admission, post- operation and discharge, there was significant difference at admission and discharge (p <0.05), while there was no significant difference at the time of postoperation (p > 0.05). The magnitude of serum calcium fluctuation was larger in femoral neck group than femoral intertrochanteric group. Concerning alkaline phosphatase and albumin levels at admission, there was no significant difference between two groups (p > 0.05). CONCLUSION: The capability of reservation and restoration of serum calcium in patients with femoral neck fracture is better than that in patients with femoral intertrochanteric fracture. A low serum calcium level may be susceptible to femoral intertrochanteric fracture.

Non-traumatic myositis ossificans circumscripta at elbow joint in a 9-year old child.

Myositis ossificans circumscripta (MOC) is a kind of self-localized, benign and tumor-like lesions often seen in adults, with approximately 75% of cases caused by trauma. We reported a case of non-traumatic MOC occurred at the elbow joint in a 9-year old child and it has been excised by surgery. After 18 months follow-up, a favorable outcome has been achieved with the Broberg-Morrey score of 100. We suggest that surgical resection should be done as soon as the diagnosis is confirmed.

Recovery of Olfactory Function in Postviral Olfactory Dysfunction Patients after Acupuncture Treatment.

Introduction. The aims of this study were to assess the impact of traditional Chinese acupuncture (TCA) in postviral olfactory dysfunction (PVOD) patients who were refractory to standardized treatment and to compare the results with the impact observed in an observation group. Methods. Fifty patients who presented to the outpatient clinic with PVOD and were refractory to standardized treatment were included: 25 were treated with TCA and 25 patients were simply observed. A subjective olfactory test was performed using the University of Pennsylvania Smell Identification Test (UPSIT). The effects of TCA were compared with the results obtained in the observation group. Results. Improved olfactory function was observed in eleven patients treated with TCA compared with four patients in the observation group. This study revealed significantly improved olfactory function outcomes in patients who underwent acupuncture compared with the observation group. No significant differences in olfaction recovery were found according to age, gender, or duration of disease between the two groups; however, hyposmic patients recovered at a higher rate than anosmic patients. Conclusion. TCA may aid the treatment of PVOD patients who are refractory to drugs or other therapies.

Should thorough Debridement be used in Fibular Allograft with impaction bone grafting to treat Femoral Head Necrosis: a biomechanical evaluation.

BACKGROUND: Fibular allograft with impaction bone grafting (FAIBG) is an effective hip-preservation method for avoiding total hip arthroplasty in the early stage of femoral head necrosis. However, whether thorough debridement should be used with FAIBG is controversial. This study compared the mechanical performance between FAIBG with and without thorough debridement, which provides a biomechanical basis for selecting the proper treatment in clinical settings. METHODS: Eighteen computational models were constructed and used to simulate two subtypes of femoral head collapse with seven debridement radii. The initial model was validated using the bony density distribution from X-ray images and a photograph of the cadaver bone cross-section. The stress of the anterolateral column and the debridement efficiency were computed and analyzed. RESULTS: (1) The peak stress of the anterolateral column in all conditions could return to the physiological level, and in two cases, the decrement/increment of stress was almost less than 0.1 % when the debridement radius increased. (2) The load share ratio (LSR) of the cortical and cancellous bone was markedly decreased in the untreated condition and increases with an increase in the debridement radius. (3) A debridement radius greater than 1/2r yields a LSR value larger than that obtained in the normal condition. CONCLUSIONS: The simulation results provide specific biomechanical evidence to support the finding that FAIBG with a debridement region of 3/8 -1/2 appears to be a better choice for resisting femoral head collapse (FHC). Furthermore, FAIBG without thorough debridement, which requires relatively simple surgical devices and reduces artificial damage, appears to be a better method for resisting FHC than FAIBG with thorough debridement.

Reconstruction of the biomechanical transfer path of femoral head necrosis: a subject-specific finite element investigation.

According to Wolff׳s law, the structure and function of bone are interdependent. The disruption of trabeculae in the necrotic femoral head destroys the biomechanical transfer path, increasing the risk of a collapse in the cortical bone. Hence, biomaterials are needed to promote osteogenesis to aid in the reconstruction of a similar biomechanical transfer path that can provide structural and biomechanical support to prevent and delay bone deterioration. Fibular allograft combined with impaction bone grafting (FAIBG) is a hip preservation method that provides both biological repair materials and biomechanical support. This method has been used successfully in the clinical setting, but it still lacks biomechanical insight. In this paper, we aim to provide a biomechanical basis for treatment using FAIBG, we used subject-specific finite element (FE) methods to analyse the biomechanical transfer characteristics of hip models: physiological, pathological and postoperative. The physiological model provided insight into the biomechanical transfer characteristics of the proximal femur. The pathological model showed an abnormal stress distribution that destroyed stress transfer capability. The postoperative model showed that FAIBG can reconstruct the biomechanical transfer path of the femoral head and reduce the risk of a collapse in the cortical bone. In conclusion, FAIBG seems to treat necrosis of the femoral head.

[Study of model establishment of unicompartmental knee athroplasty based on three-dimensional parametric modeling method].

The model of knee OA (KOA) was established in our laboratory with three-dimensional (3D) reconstruction technique based on the CT data. We then designed the unicompartmental prosthesis matching KOA model with parametric software Pro/e 5. 0. Finally, the models were used to mimic the operation of knee unicompantment replacement and the model of unicompartmental knee athroplasty (UKA) was analyzed using 3D finite element method. The results indicates that the approach for designing the model by 3D parametric is effective and meets the need of automation and efficacy to design unicompartmental prosthesis. The results proves that the model is vivid and precise, and the 3D parameteric modeling method can provide biomechanical research of unicompantment replacement with model foundation and new experimental method. It can be widely utilized in the clinics and research.

[Establishment and application of subject-specific three-dimensional finite element mesh model for osteonecrosis of femoral head].

This paper is aimed to acquire high Geometric similar Subject-specific three-dimensional (3D) finite element mesh model of hip joint containing necrotic femoral head according to individual patient's X-ray, CT and MRI by using the image registration and fusion technology. We selected a middle-aged female patient with osteonecrosis of femoral head, obtained the X-ray, CT and MRI images respectively. Then we established 3D solid model separately based on these image data by using Mimics 13. 1 and Pro/E 5.1 software. We confirmed the match points and then proceed the 2D image registration after image projection conversion. Finally we showed the 3D finite element mesh model. A highly geometric similar subject-specific 3D finite element mesh model for osteonecrosis of femoral head has been established, which included normal cortical bone, cancellous bone, articular cartilage and necrotic zone, fractured trabecular bone within the femoral head. The model truly reflects the morphological characteristics and relationship of hip joint with osteonecrosis of femoral head, provides a relatively ideal research platform for further biomechanical analysis and surgical simulation.

[Primary outcome of impacting bone graft and fibular autograft or allograft in treating osteonecrosis of femoral head].

OBJECTIVE: To evaluate the mid-term outcome of impacting bone graft and strut graft in treating osteonecrosis of the femoral head (ONFH) and to compare the effects of fibular autograft and allograft for strut graft. METHODS: From August 2004 to December 2004, 40 cases (58 hips) of ONFH were treated with impacting bone graft and nonvascular fibular autograft (autograft group) or allograft (allograft group). In the autograft group, 20 cases (27 hips) included 17 males (23 hips) and 3 females (4 hips) with an average age of 41 years (22-53 years); 22 hips were at stage II and 5 hips at stage III according to the classification system of Association Research Circulation Osseous (ARCO). In the allograft group, 20 cases (31 hips) included 17 males (25 hips) and 3 cases females (6 hips) with an average age of 40 years (18-55 years); 23 hips were at stage II and 8 hips at stage III according to the classification system of ARCO. The outcome was evaluated both clinically by Harris hip score (HHS) and radiologically by X-rays. The related complications were recorded. The end-point of observation was determined when further salvage operation or total hip arthroplasty was needed. RESULTS: All cases were followed up for 36-40 months (mean 37.5 months), 25 hips (92.6%) preserved femoral heads in autograft group and 28 hips (90.3%) in allograft group. Harris score in autograft and allograft groups was increased significantly from 70.82 +/- 8.26 and 69.94 +/- 9.59 before operation to 86.36 +/- 6.27 and 87.45 +/- 7.03 at the last follow-up, respectively, indicating a significant difference between before and after operation in two groups (P < 0.05), but no significant difference between two groups (P > 0.05). The radiological results showed that 17 hips (63.0%) in autograft group and 21 hips (67.8%) in allograft group improved or had no further collapse; and 20 hips (74.1%) in autograft group and 22 hips (71.0%) in allograft group were in good repair, indicating no significant difference between two groups (P > 0.05). The postoperative complication occurred after weight-bearing walk in the autograft group and during wound healing stage in the allograft group. CONCLUSION: For selected cases of femur head necrosis, the treatment with modified impacting bone graft and strut graft has a satisfactory mid-term outcome. The results of fibular autograft and fibular allograft had no significant difference.

[Study on correlation between pain grading, stage of necrosis and bone marrow-edema in nontraumatic osteonecrosis of femoral head].

OBJECTIVE: To explore the correlation between pain grading, stage of necrosis and bone marrow edema (BME) in nontraumatic osteonecrosis of femoral head (NONFH) so as to strengthen understandings about clinical significance of BME in NONFH. METHODS: From October 2004 to October 2006, 97 patients (149 hips) with NONFH were treated. There were 68 males and 29 femals with an average age of 38.8 years (19-62 years). The disease course was from 20 days to 4 years. BME was identified grade 0 to grade 2 according to MRI. Based on grading scale of pain, pain grading were divided into no pain (grade 0), mild pain (grade 1) and moderate or severe pain (grade 2). According to Association Research Circulation Osseous staging system, NONFH were divided into I-IV stages. The incidence rate of BME in each pain grading and stages of necrosis was analyzed respectively. Contingency table analyses and rank sum tests were used to compare the difference of pain grading and stages of necrosis among these groups. RESULTS: The total incidence rate of BME was 73.15% (109/149), the incidence rates were 84.38% in pain groups (108/128) and 94.12% in the grade 2 (32/34). Pain grading correlated with BME rating (P < 0.001). The results of rank sum tests for several independent samples showed significant difference in BME among pain groups(P < 0.001). With the advance of pain scale, the mean rank of BME increased gradually (28.19 for grade 0, 78.94 for grade 1 and 96.12 for grade 2). BME was more commonly and clearly seen in stage II (77.05%) and stage III (82.81%) of NONFH. Stage I-III of NONFH correlated with BME rating (P < 0.001). The results of rank sum tests showed significant difference in BME rating among three stages (P < 0.001). With the advance of disease, the rank of BME rating increased gradually (39.07 for grade 0, 60.16 for grade 1 and 86.15 for grade 2). CONCLUSION: BME is a sign that is accompanied with NONFH. The probability and extent of BME correlated well with the pain and stage of NONFH. The condition of BME can be used as a index for the appraisal of advancement of disease and the judgment of treatment result.