Comparison of Novel 3D-printed Stepped Porous Metal Cones and Metaphyseal Sleeves for Reconstruction of Severe Knee Bone Defects: Short-term Clinical Outcomes.

OBJECTIVE: Both porous metal cones and metaphyseal sleeves are excellent implants for reconstructing severe bone defects in the knee joint, but they both exhibit design limitations. The porous metal cone, especially, has significant room for improvement in its shape design. The existing porous metal cones often feature a conical external surface with a relatively small taper, potentially compromising both rotational and axial stability. To improve both axial and rotational stability in porous metal cones, we developed a 3D-printed stepped porous metal cone. This study aimed to assess the short-term clinical outcome of the 3D-printed stepped porous metal cone and to compare it with the clinical outcome of patients who underwent revision total knee arthroplasty (rTKA) with the metaphyseal sleeves during the same period. METHOD: Patients who underwent total knee arthroplasty revision with metaphyseal bone defect reconstruction from 2019 to 2021 were retrospectively analyzed. A total of 61 patients were enrolled in the study, including 15 patients using 3D-printed stepped porous metal cones and 46 patients using metaphyseal metal sleeves. Thirty patients using metaphyseal sleeves were screened by propensity score matching method and compared with those using stepped cones. Analysis included the American Knee Society Score, the Hospital for Special Surgery knee score, the Western Ontario and McMaster Universities Arthritis index, the Short Form 12 (SF-12) health survey, and radiographic assessment with a mean follow-up of 28.5 ± 8.3 months. To conduct comparative analyses, unpaired Student's t-tests were employed for continuous variables, while categorical variables were analyzed using the appropriate Fisher exact or chi-squared test. RESULTS: In this study, the survival rates of both the stepped cone and metaphyseal sleeve were 100%. There was no statistically significant difference in postoperative knee function scores between the two groups (p > 0.05). However, patients in the cone group had significantly higher mental component summary scores on the SF-12 scale (p < 0.05) and higher increases in mean postoperative physical component summary scores than patients in the sleeve group (p < 0.05). In addition, patients in the cone group experienced fewer intraoperative and postoperative complications compared to the sleeve group. CONCLUSION: The 3D-printed stepped porous metal cone can effectively reconstruct bone defects in complex rTKA and provide satisfactory early clinical and radiographic results. The 3D-printed stepped cone provides a more stable structure similar to the sleeve while maintaining the original benefits of the cone making it a promising choice for rTKA.

The application of custom-made 3D-printed titanium augments designed through surgical simulation for severe bone defects in complex revision total hip arthroplasty.

BACKGROUND: With the development of radiology and three-dimensional (3D) printing technology, custom-made 3D-printed titanium augments have been more widely used. However, the radiological and clinical outcomes of custom-made augments lack reports. To better understand the clinical effect of using 3D-printed titanium augments and the significance of accurate placement, the aim of this study was to assess the outcomes when using custom-made 3D-printed titanium augments and to validate the idea that surgical simulation should be done before designing custom-made augments. METHODS: A retrospective review was conducted on 31 surgical simulations and revision total hip arthroplasties using custom-made 3D-printed titanium augments. The safe zone, cup position, and hip rotation center were measured on anteroposterior radiographs. Clinical outcomes were assessed with a mean 21.1 months of follow-up. RESULTS: All patients were positioned within the safe zone, and none of the acetabular cups nor the custom-made augments had any evidence of migration at the latest follow-up. A strong correlation was found between the planned cup position and the postoperative position. The average vertical position of the center of rotation was significantly increased from 3.55 cm to 2.35 cm. The mean Harris Hip Score was increased from 40.81 preoperatively to 65.46 postoperatively. Complications included gait abnormality, groin pain, fracture of the greater trochanter, and partial palsy of the sciatic nerve. However, patient satisfaction reached 92.3%. CONCLUSION: Surgical simulations help to design custom-made augments accurately and improve surgical plans. Acetabular components supported with custom-made 3D-printed augments is a useful method to bridge severe bone deficiencies. In this study, both the radiologic results and clinical outcomes were favorable. LEVEL OF EVIDENCE: Level 4.

[A method for smear removal of push-broom imaging spectrometers].

Smear is an inherent problem of area CCD and there have been many researches on how to deduct it. However, the imaging model of push-broom imaging spectrometer is very special, in which the usual methods are no longer applicable. To develop a new method that is suitable for the application of imaging spectrometer, a more detailed model was built. The problem of distortion of usual method was also analyzed and simulated. The original image of each channel was used to estimate the spectral distribution of the target, by which the contribution of smear of the black optical channel to each channel is quantified. Both simulation and restoration result of the remote sensing image showed that the new method worked well for the CCD smear deduction of push-broom imaging spectrometer.

Intracellular B7-H4 suppresses bile duct epithelial cell apoptosis in human primary biliary cirrhosis.

The expression and function of B7-H4, a recently identified co-inhibitory molecule of the B7 superfamily, in the pathogenesis of primary biliary cirrhosis (PBC) is still unclear. Here the expression of B7-H4 in sections from PBC patients (n = 16) was examined by immunohistochemistry and it was detected in primary bile duct epithelial cells (BECs) which were isolated from PBC patients by flow cytometry (FACs). Moreover, we also analyzed BECs-associated B7-H4 function through knock-down of its expression via RNA interference (RNAi) in vitro. Immunohistochemistry and FACs evidenced that the expression of B7-H4 was restricted in the cytoplasm of BECs from PBC patients, while it was completely absent in normal liver tissues. The cytoplasmic B7-H4 gene was cloned, and sequenced analysis showed it was encoded by the same gene to the membrane B7-H4. Interesting, silencing B7-H4 by specific RNAi resulted in enhanced FasL expression and BEC apoptosis. Conversely, interruption of Fas\FasL interaction with using FasL blocking antibodies (clone 4H9) reversed cell apoptosis. Our results suggested that the intracellular B7-H4 appears to prevent Fas/FasL-mediated BEC apoptosis during the progression of PBC, and indicates B7-H4 is a possible target for therapeutic intervention of this disease.

Up-regulation of the expression of costimulatory molecule CD40 in hepatocytes by hepatitis B virus X antigen.

Hepatitis B virus (HBV) is a major causative agent of hepatocellular carcinoma (HCC) but the pathogenesis remains poorly understood. To provide novel insights into the pathogenesis of HBV, we examined the expression profile of HBV-positive HepG2.2.15 and -negative HepG2 cells. Genes that were markedly up- or down-regulated in the presence of HBV are involved in signal transduction, apoptosis, transcriptional regulation, protein degradation and oncogenesis. Among the analyzed co-signaling molecules CD40, CD80, CD86, B7-H1, B7-DC, OX40, and B7RP-1, CD40 was the only one up-regulated. Following establishment of stable HepG2 cell lines transfected with HBV genes, we found that HBxAg up-regulated the expression of CD40. We also found that CD40 activation by CD40L could promote the expression of negative co-signaling molecule B7-H1, rather than induce the apoptosis of HepG2HBx cell as expected. These results suggest that CD40 up-regulation by HBxAg may play a facilitating role in the pathogenesis causing HCC.

Mutual activation of CD4+ T cells and monocytes mediated by NKG2D-MIC interaction requires IFN-gamma production in systemic lupus erythematosus.

The activating receptor NKG2D is mainly expressed by human CD8(+) T cells and NK cells but normally absent on CD4(+) T cells. However, a subset of autoreactive NKG2D(+)CD4(+) T cells has been found to exist in some autoimmune disease such as rheumatoid arthritis (RA) and to participate in the imbalance of immune response and inflammation. Up to date this observation has been extended to some autoimmune diseases such as RA and Crohn's disease and the mechanism underlying the presence of this type of NKG2D(+)CD4(+) T cells has not been delineated yet. In this study, we found that a substantial proportion of CD4(+) T cells expressed NKG2D in the PBMC of SLE patients. We also found that monocytes in SLE aberrantly expressed the NKG2D ligand of MHC class I chain-related (MIC) molecules and membrane-bound IL-15 (mIL-15) at the cell surface. When cultured with the sera from SLE patients, the monocytes from healthy volunteers could be induced to express MIC and mIL-15. However, this induced expression of MIC and mIL-15 could be blocked with anti-IFN-gamma receptor (anti-IFN-gammaR) antibody. We further demonstrated that NKG2D could be induced on normal CD4(+) T cells either cocultured with monocytes from patients with SLE, or monocytes from healthy volunteers but pretreated with IFN-gamma. Moreover, Th1 cytokines were found to be produced by NKG2D(+)CD4(+) T cells in the coculture system. By transwell assay, we found that both NKG2D expression and Th1 cytokines production depended on the cell-cell contact. These results indicate that the elevated sera IFN-gamma may be responsible for MIC and mIL-15 induction on monocytes in SLE; mIL-15 on monocytes contribute to NKG2D receptor induction on a subset of CD4(+) T cells. Moreover, CD14(+) monocytes promote NKG2D(+)CD4(+) T cells activation through the NKG2D-MIC engagement in the pathogenesis of SLE.

Induced B7-H1 expression on human renal tubular epithelial cells by the sublytic terminal complement complex C5b-9.

The co-inhibitory molecule B7-H1 has been broadly detectable on human inflammatory renal tubular epithelial cells (TECs) and is proposed to limit tubular damage through down-regulation of tubulointerstitial infiltration T cell activation. Nevertheless, factors that initiate B7-H1 expression on TECs remain unclarified. The terminal complement complex C5b-9, which deposits diffusely on tubules and glomerules of diseased kidneys, is now recognized as a mediator that triggers cellular activation rather than inducing cell death. Whether the up-regulation of B7-H1 on tubules is also induced by C5b-9 is uncertain. Here, after assembling functional sublytic C5b-9 on the membranes of TECs based on purified complement components, we found that B7-H1 gene transcription and protein synthesis was enhanced by C5b-9. Promoter constructs in a luciferase assay, site-directed mutagenesis and laser scanning confocal microscopy assay (LSCM) revealed that the transcription factor NF-kappaB is primarily responsible for C5b-9-mediated B7-H1 expression. To further detect the physiologic function of B7-H1, triggering B7-H1 with its agonist mAb (clone 5H1) profoundly enhanced Fas expression on C5b-9-treated TECs and thus induced TEC apoptosis. Interestingly, pretreatment of TECs with Fas blocking antibodies prevented this effect. Our results propose that C5b-9 regulates tubular pathogenesis in glomerulonephritis or other renal autoimmune diseases, possibly through enhances cell apoptosis mediated by B7-H1 signals, in addition to it directly promotes tubular damage.

Terminal complement complex C5b-9-treated human monocyte-derived dendritic cells undergo maturation and induce Th1 polarization.

Sublytic C5b-9 has been described as a pro-inflammatory mediator that triggers cell activation rather than inducing cell death. Dendritic cells (DC) play a critical role in controlling antigen-specific immune responses. Although DC maturation induced by various stimuli has been well characterized, the role of C5b-9 in DC function has not been described. In this report, we use in vitro assembled functional C5b-9 based on purified distal complement protein to show that DC maturation is promoted by sublytic C5b-9. This was demonstrated by up-regulation of CD83, HLA-antigens and costimulatory molecules, including CD80, D86, B7-H1, B7-H3, B7-H4 and BTLA. In addition, secretion of cytokines such as interleukin (IL)-12 and tumor necrosis factor-alpha was increased while the capacity for antigen uptake (FITC-Dextran and Lucifer Yellow) was reduced in C5b-9-treated DC. Mixed lymphocyte reactions indicated that C5b-9-activated DC acted as stimulators that significantly promoted CD4+ T cell activation and elicited production of cytokines, including interferon-gamma and IL-2. Interestingly, C5b-9-treated DC also orient CD4+ CD45RA+ naïve T cells toward Th1 polarization. Our results are the first to report that DC are potential immunoregulatory targets of C5b-9, suggesting that C5b-9 bridges innate and acquired immunity by inducing DC maturation.