The Expression and Diagnostic Value of LncRNA H19 in the Blood of Patients with Osteoarthritis.

BACKGROUND: To investigate the expression and diagnostic value of LncRNA H19 in the blood of patients with osteoarthritis. METHODS: A total of 130 cases of patients with osteoarthritis admitted to Jinling Hospital, Nanjing, China from Jun 2016 to Jul 2017 were elected as the study group, and 100 patients who underwent physical examination in Jinling Hospital during the same period were selected as the control group. The differences in expression levels of LncRNA H19 between the two groups were compared, the diagnostic value of LncRNA H19 in osteoarthritis and its relationship with clinical characteristics of patients with osteoarthritis were analyzed. RESULTS: The expression level of LncRNA H19 increased in peripheral blood of patients with osteoarthritis (P<0.05). The AUC, critical value, sensitivity and specificity of the diagnosis of osteoarthritis were 0.891, 1.879, 96.00% and 85.73%, respectively. The expression level of LncRNA H19 was related to K-L grading, and the expression level of LncRNA H19 increased with K-L grading. Pearson correlation analysis showed that LncRNA H19 was negatively correlated with bone metabolism indexes PINP, N-MID, BGP, BALP and Lysholm score (P<0.05), and positively correlated with bone metabolism indexes ß-CTX, VAS score and WOMAC score (P<0.05). CONCLUSION: LncRNA H19 is highly expressed in peripheral blood of patients with osteoarthritis, which is closely related to the occurrence and development of osteoarthritis and has a good diagnostic value for osteoarthritis.

ALKBH5-mediated m6A demethylation of lncRNA PVT1 plays an oncogenic role in osteosarcoma.

BACKGROUND: Osteosarcoma (OS) is one of the most common malignant bone tumors. Plasmacytoma variant translocation 1 (PVT1) is a well-known oncogenic long noncoding RNA (lncRNA). However, to date, the regulatory mechanism of PVT1 upregulation in OS remains unknown. METHODS: qRT-PCR was carried out to test the expression level of PVT1 and ALKBH5. RNA immunoprecipitation (RIP) and RNA pull-down assays were performed to detect the interaction of PVT1 with ALKBH5 and YTHDF2. Methylated RNA immune-precipitation (MeRIP) was used to examine the N 6-methyladenosine (m6A) modification of PVT1 transcript. RESULTS: In this study, we found that PVT1 expression was upregulated in OS tissues and cells and significantly related with clinical stage, tumor size, and prognosis of patients with OS. Further investigation revealed that N 6-methyladenosine (m6A) demethylase ALKBH5 could associate with PVT1 and suppress its degradation. ALKBH5 decreased the m6A modification of PVT1, thus inhibiting the binding of reader protein YTHDF2 in PVT1. Functionally, ALKBH5-mediated PVT1 upregulation promoted the OS cell proliferation in vitro and tumor growth in vivo. CONCLUSIONS: Our study suggests that ALKBH5-mediated m6A modification of PVT1 contributes to OS tumorigenesis.

Long non-coding RNA DANCR regulates proliferation and apoptosis of chondrocytes in osteoarthritis via miR-216a-5p-JAK2-STAT3 axis.

Osteoarthritis (OA) is one of the most common chronic joint disease. Long non-coding RNAs (lncRNAs) have been confirmed to play important roles in a variety of diseases including OA. However, the underlying mechanism of lncRNA differentiation antagonizing non-protein coding RNA (DANCR) in OA has not been well elucidated. The expression of DANCR in cartilage tissues from OA patients was detected using quantitative real-time PCR. After cell transfection, the effects of DANCR inhibition on the proliferation, apoptosis and inflammatory factors of OA chondrocytes were detected using Cell Counting Kit-8 assay and flow cytometry assay. Novel target of DANCR was then identified through bioinformatics analysis and confirmed by luciferase reporter assay and RNA immunoprecipitation assay. The expression of DANCR was significantly increased in OA patients. Function assays demonstrated that DANCR suppression inhibited the proliferation, inflammation, and promoted apoptosis of chondrocytes cells. Additionally, DANCR regulated survival of OA chondrocytes through acting as a competitive endogenous RNA for miR-216a-5p. Furthermore, JAK2 was a direct target of miR-216a-5p, and DANCR regulated the JAK2/STAT3 signal pathway through miR-216a-5p in OA chondrocytes. In the present study, we concluded that DANCR promoted the proliferation, inflammation, and reduced cell apoptosis in OA chondrocytes through regulating miR-216a-5p/JAK2/STAT3 signaling pathway, indicating DANCR might be a useful biomarker and potential therapeutic target for OA treatment.

miR-338-5p Regulates the Viability, Proliferation, Apoptosis and Migration of Rheumatoid Arthritis Fibroblast-Like Synoviocytes by Targeting NFAT5.

BACKGROUND/AIMS: MicroRNAs (miRNAs) have been reported to be involved in Rheumatoid arthritis (RA) pathogenesis and prognosis. However, little is known about the disease mechanism in RA. Here, we aim to investigate the potential association between miR-338-5p and NFAT5 in RA. METHODS: Aberrant expression of miR-338-5p in RA tissues and rheumatoid arthritis fibroblast-like synoviocytes (RAFLSs) compared to the normal were determined by RT-qPCR. Cell viability was determined using the CCK-8 assay, and cell apoptosis was analyzed via Annexin V-FITC/PI double staining and was detected using flow cytometry. The targeted relationship was determined by TargetScan database and dual luciferase reporter gene assay. RESULTS: Upregulation of miR-338-5p facilitated the proliferation, migration, invasion and induced G0/G1 arrest of RAFLSs while miR-338-5p inhibitor functioned oppositely. Nuclear factor of activated T-cells 5 (NFAT5) was confirmed as a downstream target of miR-338-5p which expression was directly suppressed by miR-338-5p. Overexpression of NFAT5 attenuated the proliferation and metastasis of RAFLSs and those changes could be rescued by co-transfection of miR-338-5p. CONCLUSION: miR-338-5p promotes RAFLS's viability and proliferation, migration by targeting NFAT5, suggesting a novel therapeutic strategy for RA.

Long noncoding RNA DANCR regulates miR-1305-Smad 4 axis to promote chondrogenic differentiation of human synovium-derived mesenchymal stem cells.

miRNAs have been reported to regulate cellular differentiation by modulating multiple signaling pathways. Long noncoding RNA (lnc RNA) DANCR was previously identified to be critical for the chondrogenesis of human synovium-derived mesenchymal stem cells (SMSC), however, the underlying molecular mechanism requires better understanding. Here, miRNA expression profiling in DANCR overexpressed in SMSCs identified significant down-regulation of miR-1305, which serves as a downstream target of DANCR. Notably, miR-1305 overexpression reversed DANCR-induced cell proliferation and chondrogenic differentiation of SMSCs, which suggested that miR-1305 antagonized the function of DANCR. Mechanistically, highly expressed miR-1305 resulted in the decreased expression of the TGF-ß pathway member Smad4, and inhibition of miR-1305 enhanced the expression level of Smad4. Depletion of Smad4 suppressed the promotion of DANCR in cell proliferation and chondrogenesis of SMSCs. Collectively, our results characterized miR-1305-Smad4 axis as a major downstream functional mechanism of lncRNA DANCR in promoting the chondrogenesis in SMSCs.

[Effect of Jumbo cups for total hip arthroplasty revision on femoral offset and hip center of rotation].

Objective: To investigate the change of the femoral offset and hip center of rotation (COR) after using Jumbo cups in total hip arthroplasty (THA) revision. Methods: The clinical data of 23 patients who underwent THA revision using Jumbo cups between January 2010 and May 2015 were retrospectively analyzed. Morselized bone graft was performed on 8 cases, morselized bone graft combined with structural bone graft on 10 cases. There were 10 males and 13 females, aged 65.4 years on average (range, 51-77 years). The disease duration was 1-24 years (mean, 8.57 years). The reasons for revision included aseptic loosening in 21 cases and periprosthetic infection in 2 cases. The Harris hip score and visual analogue scale (VAS) were 43.04±5.05 and 5.70±0.97 before operation respectively. According to the Paprosky acetabular defect classification, there were 5 cases of type I, 5 cases of type II A, 3 cases of type II B, 6 cases of type II C, and 4 cases of type III A. The X-ray films showed that the femoral offset was (40.65±4.09) mm for normal side and was (44.04±5.08) mm for affected side at preoperation, showing significant difference ( t=4.098, P=0.000). Ten patients underwent femoral offset reconstruction (43.48%) but 13 patients did not (56.52%) before operation. The COR was reconstructed in 10 cases (43.48%); COR elevation was observed in 11 cases (47.83%), and COR decline in 2 cases (8.69%) before operation. Results: Primary healing of incision was obtained in all patients, with no complication of infection, vascular injury, deep vein thrombosis, dislocation of the joint, or fracture around prosthesis. All the patients were followed up 12-76 months (mean, 22.48 months). The Harris hip score and VAS were 82.09±4.53 and 0.74±0.62 at 1 year after operation respectively, showing significant differences when compared with preoperative scores ( t=37.831, P=0.000; t=22.318, P=0.000). The X-ray films showed that the femoral offset was (43.87±3.57) mm for affected side at 1 year after operation, showing no significant difference when compared with preoperative one ( t=0.250, P=0.805), but significant difference was found between affected side and normal side ( t=5.591, P=0.000). The femoral offset was restored in 16 patients (69.57%) and was not restored in 7 patients (30.43%) after operation. The COR was restored in 15 patients (65.22%) and was not restored in 8 patients (34.78%). Conclusion: Using Jumbo cups or combined with morselized or structural bone graft is effective in restoring hip COR and femoral offset at the maximum limit in THA revision, with good short-term outcome and improved stability of acetabular prosthesis.

BDKRB2 +9/-9 bp polymorphisms influence BDKRB2 expression levels and NO production in knee osteoarthritis.

The bradykinin B2 receptor (BDKRB2) plays a key role in the inflammation process of osteoarthritis. Nitric oxide has also long been considered to be a catabolic factor that contributes to inflammatory response and the osteoarthritis disease pathology. Several studies have reported that the BDKRB2 +9/-9 bp polymorphisms are associated with transcription of the receptor. However, the roles of BDKRB2 polymorphisms in inflammation in osteoarthritis remain unclear. This study enrolled 156 subjects with primary knee osteoarthritis and 58 healthy volunteers. BDKRB2 polymorphisms were genotyped, and the mRNA and protein levels of BDKRB2 in synovial tissues from osteoarthritis patients were measured by quantitative real-time polymerase chain reaction and western blot analysis, respectively. Nitric oxide production in serum from patients with osteoarthritis was measured using a nitric oxide assay kit. We found that the mean BDKRB2 mRNA levels were significantly higher in Kallgren-Lawrence grade-4 osteoarthritis patients than patients with lower grade osteoarthritis. The +9/-9 bp polymorphisms significantly affected the BDKRB2 mRNA and protein expression levels in synovial tissues from osteoarthritis subjects. Osteoarthritis patients with +9/-9 and -9/-9 genotypes had higher BDKRB2 expression levels in synovial tissue and nitric oxide production in serum. Moreover, positive correlation was found between the BDKRB2 levels in synovial tissue and nitric oxide production. Compared with health controls, significant increases of nitric oxide production in osteoarthritis were detected which were associated with increasing severity of osteoarthritis. Multiple linear regression analysis (adjusted for gender and age) showed serum nitric oxide level was positively associated with BDKRB2 polymorphism and Kallgren-Lawrence grade and was inversely associated with obesity. Our findings showed that the BDKRB2 +9/-9 bp polymorphisms affected the gene expression and nitric oxide production, which were associated with radiographic severity of osteoarthritis, suggesting that the BDKRB2 +9/ -9 bp polymorphisms may act as a genetic modulator of osteoarthritis, and play an essential role in inflammatory process in osteoarthritis.

Long Noncoding RNA DANCR Is a Positive Regulator of Proliferation and Chondrogenic Differentiation in Human Synovium-Derived Stem Cells.

Cartilage tissues have limited capacity for repair after damage and then cause osteoarthritis, so finding alternative treatment is ongoing. Mesenchymal stem cells (MSCs) have become a promising therapy for cartilage damage and diseases due to the advantages of easy separation, high proliferative potentiality, and genetic stability. Synovium-derived MSCs (SMSCs) have been recognized as an ideal source for cartilage repair. In our previous study, we found that Sox4 promoted proliferation and chondrogenesis of SMSCs through upregulation of long noncoding RNA (lncRNA) DANCR. However, the exact molecular mechanism by which DANCR promotes proliferation and chondrogenesis of SMSCs remains unknown. In the present study, we investigated the effect of lncRNA DANCR on the proliferation and chondrogenesis of SMSCs. We found that overexpression of DANCR could promote proliferation and chondrogenesis of SMSCs, while knockdown of DANCR had the opposite effect. Moreover, our data demonstrated that DANCR directly interacted with myc, Smad3, and STAT3 mRNA to regulate their stability. Finally, we found that the promotion of SMSC proliferation induced by DANCR depended on myc. Also, DANCR activated chondrogenesis of SMSCs via upregulation of Smad3 and STAT3 expression. Our growing knowledge of the role of DANCR is pointing toward its potential use as a novel therapeutic approach for cartilage damage and diseases.

Harmful Effects of Leukocyte-Rich Platelet-Rich Plasma on Rabbit Tendon Stem Cells In Vitro.

BACKGROUND: Platelet-rich plasma (PRP) is now widely used as a promising treatment for patients with tendinopathy. However, the efficacy of PRP treatment for tendinopathy is controversial mainly because of inconsistent results from human clinical trials and particularly because the concentration and effect of leukocytes in PRP remain largely unknown. HYPOTHESIS: Leukocyte-rich PRP (L-PRP) inhibits growth factor release, decreases proliferation, and induces nontenocyte differentiation of tendon stem cells (TSCs); increases catabolic cytokine concentrations; and causes inflammation and apoptosis. Thus, L-PRP has a detrimental effect on tendon stem/progenitor cells, which impairs injured tendon healing. STUDY DESIGN: Controlled laboratory study. METHODS: Pure PRP (P-PRP) and L-PRP were prepared from the same individual rabbit blood, and platelet numbers in each PRP product were adjusted to reach the same level. The leukocyte level in L-PRP was 4 and 8 times higher than those in whole blood and P-PRP, respectively. The growth factors in both P-PRP and L-PRP were measured by enzyme-linked immunosorbent assay kits. The morphology, stemness, proliferation, and differentiation of TSCs grown in L-PRP and P-PRP were examined by microscopy, immunocytochemistry, population doubling time, quantitative real-time polymerase chain reaction, and histological analysis. RESULTS: L-PRP produced lower levels of growth factors, such as vascular endothelial growth factor (VEGF), epidermal growth factor (EGF), transforming growth factor (TGF)-ß1, and platelet-derived growth factor (PDGF), than did P-PRP. TSC proliferation was significantly decreased in L-PRP in a concentration-dependent manner. Furthermore, TSCs cultured in P-PRP produced more collagen and formed tendon-like tissue; however, TSCs grown in L-PRP differentiated into nontenocytes and produced more inflammatory factors such as membrane-associated prostaglandin synthase (mPGES) and interleukin (IL)-1ß. Moreover, L-PRP was associated with increased apoptosis. CONCLUSION: L-PRP has harmful effects on TSCs. CLINICAL RELEVANCE: This study revealed the direct effects of different compositions of PRP on TSCs and provided basic scientific data to help understand the cellular and molecular mechanisms of the efficacy of PRP treatment in clinical use.

TheBDKRB2 +9/-9 Polymorphisms Influence Pro-Inflammatory Cytokine Levels in Knee Osteoarthritis by Altering TLR-2 Expression: Clinical and in Vitro Studies.

BACKGROUND/AIMS: The bradykinin B2 receptor (BDKRB2) +9/-9 gene polymorphisms have been shown to be associated with the susceptibility and severity of osteoarthritis (OA); however, the underlying mechanisms are unclear. In this study, we investigated the correlation between the BDKRB2 +9/-9 polymorphisms and pro-inflammatory cytokine levels in OA and the molecular mechanisms involved. METHODS: A total of 156 patients with primary knee OA and 121 healthy controls were enrolled. The BDKRB2 +9/-9 polymorphisms were genotyped. The tumor necrosis factor (TNF)-α, interleukin (IL)-1ß, IL-6, and IL-8 levels were determined using Enzyme-linked immunosorbent assay (ELISA). The toll-like receptor (TLR)-2 and TLR-4 mRNA levels were determined by quantitative real-time PCR. The basal and bradykinin-stimulated pro-inflammatory cytokine secretion in human OA synoviocytes and the involvement of TLR-2 and mitogen-activated protein kinases (MAPKs) were investigated. RESULTS: The presence of -9 bp genotype is associated with higher TNF-α, IL-6, and IL-8 levels and higher TLR-2 expression in OA patients. The basal and bradykinin-induced TLR-2 expressions in human OA synoviocytes were significantly reduced by specific inhibitors of p38, JNK1/2, and ERK1/2. Both the B2 receptor antagonist MEN16132 and TLR-2 silencing inhibited IL-6 and IL-8 secretion in human OA synoviocytes. CONCLUSION: The data suggested that the BDKRB2 +9/-9 polymorphisms influence pro-inflammatory cytokine levels in knee osteoarthritis by altering TLR-2 expression.

Sox4 enhances chondrogenic differentiation and proliferation of human synovium-derived stem cell via activation of long noncoding RNA DANCR.

Mesenchymal stem cells (MSCs) have several features that make them an attractive option for potentiating cartilage repair. Synovium-derived (SMSCs) have been recently recognized as an excellent source. SRY-related HMG-box (Sox) family plays an important role in the proliferation and differentiation of SMSCs. However, the role of Sox4 in human SMSCs remains elusive. In the present study, we investigated the role of Sox4 in SMSCs through gain-of-function studies and found that Sox4 promoted cell proliferation and chondrogenesis. Furthermore, Sox4 could directly bind to the promoter of long noncoding RNA DANCR and increased its expression. Finally, knockdown of DANCR could reverse the stimulative effect of Sox4 on the proliferation and chondrogenesis of SMSCs. Taken together, our data highlights the pivotal role of Sox4 in the proliferation and differentiation of SMSCs.

Systematic screen with kinases inhibitors reveals kinases play distinct roles in growth of osteoprogenitor cells.

Cancer treatment-related bone loss has become growing problematic, especially in breast and prostate cancer treated with hormone/endocrine therapy, chemotherapy and radiotherapy. However, bone loss caused by targeted therapy in cancer patients is largely unknown yet. In present study, a kinase inhibitors screen was applied for MC3T3-E1, a murine osteoprogenitor cell line, and seven kinase inhibitors (GSK1838705A, PF-04691502, Dasatinib, Masitinib, GDC-0941, XL880 and Everolimus) were found to suppress the cell viability with dose- and time-dependent manner. The most interesting is that many kinase inhibitors (such as lapatinib, erlotinib and sunitinib) can promote MC3T3-E1 cell proliferation at 0.01 µM. 4 out of 7 inhibitors were selected to perform the functional study and found that they lead to cell cycle dysregulation, treatments of PF-04691502 (AKT inhibitor), Dasatinib (Src inhibitor) and Everolimus (mTOR inhibitor) lead to G1 arrest of MC3T3-E1 cells via downregulation of cyclin D1 and p-AKT, whereas XL880 (MET and VEGFR inhibitor) treatment results in increase of sub-G1 and G2/M phase by upregulation of p53 protein. Our work provides important indications for the comprehensive care of cancer patients treated with some targeted drugs.

Free fatty acids are responsible for the hidden blood loss in total hip and knee arthroplasty.

Hidden blood loss (HBL), commonly seen post total knee or hip arthroplasty, causes postoperative anemia even after reinfusion or blood transfusion based on the visible blood loss volume. The mechanism of HBL remains unclear although more than one theory had tried to explain it. Free fatty acids, metabolites of fatty emboli that are generated during TKA, THA and other surgery manipulating the medullary canal of femur, had been demonstrated to stimulate the neutrophils in producing reactive oxygen species such (ROS) as hydrogen peroxide and chlorous peroxide. Erythrocytes injury was also shown in parasitic infection, chronic renal disease and paroxysmal nocturnal hemoglobinuria in a mechanism of oxidation of membrane polyunsaturated fatty acids and cytosolic hemoglobin by ROS. Based on these results we hypothesize that free fatty acids generated from fatty emboli in blood circulation are responsible for the hidden blood loss through peroxidating injury of membrane molecules of RBC and hemoglobin. Antioxidants administered intra- or post-operatively are predicted to play a protective role in erythrocytes oxidation and potentially reduce the volume of hidden blood loss after arthroplasty.

Lesser trochanteric osteotomy in total hip arthroplasty for treating CROWE type IV developmental dysplasia of hip.

PURPOSE: The study was designed to evaluate the efficacy and safety of lesser trochanteric osteotomy for femoral shortening in total hip arthroplasty in treatment of 28 cases of CROWE IV developmental dysplasia of the hip (DDH). METHODS: Patients underwent progressive femoral shortening at the level of lesser trochanteric to make reduction possible into the anatomical acetabulum in all hips. The results were collected and evaluated clinically and radiographically. RESULTS: The mean follow-up period was 55.3 months. The average postoperative leg length discrepancy was eight millimetres for unilateral THA patients. A modified Merle d'Aubigné scale was improved from 9.3 preoperatively to 15.9 postoperatively. Sciatic nerve palsy was confirmed in two hips which resolved completely in six months. The Trendelenburg sign was positive in two hips at the final follow-up. No revision surgery was required by the final follow-up. CONCLUSION: Lesser trochanteric osteotomy proved to be safe and effective in femoral shortening for treatment of CROWE IV DDH without the problem of nonunion at the site of osteotomy.

[Early clinical research of total hip arthroplasty for the treatment of old acetabular fractures].

OBJECTIVE: To analyze the early clinical effects of total hip arthroplasty(THA) for the treatment of old acetabular fractures. METHODS: From January 2007 to June 2010, thirteen patients with old acetabular fractures were reviewed, including 10 males and 3 females. Ten patients were treated with internal fixation and conservative treatment had been used in three patients. The average Harris Hip Score was used to evaluate therapeutic effects. RESULTS: After operation, all thirteen patients were followed up for one year. Hip X-ray films were taken and prosthesis loosening was not seen on any of the films at the 1st year after operation. The Harris Hip Score improved from preoperative (37.19 +/- 20.12) to postoperative (83.38 +/- 3.33), there was statistically significant difference. CONCLUSION: For reasons of malunion or failure of internal fixation, large and various bone defect, it's difficult to reach the anatomical reduction. THA is a good treatment method, but it needs rich skills and experience compared with ordinary operation.

[Early rehabilitation after simultaneously bilateral total knee arthroplasty].

OBJECTIVE: To investigate the principle and methods of preoperative and postoperative rehabilitation for simultaneous bilateral total knee arthroplasty. METHODS: From January 2005 to June 2008, 72 patients (144 knees) were reviewed in the study, including 33 males and 39 females, ranging in age from 46 to 78 years, with an average age of 69 years. There were 54 patients with osteoarthritis, 17 patients with RA, and 1 patient with traumatic osteoarthritis, including 10 cases (15 knees) of fixed varus deformity more than 30 degree and 6 cases (8 knees) of fixed vagus deformity more than 15 degree. Rehabilitation protocol was made for preoperative, early postoperative and late postoperative stages. Patients were encouraged to initiate the exercises at the early postoperative stage on the premise of multimodal analgesia. Knee function and pain were evaluated using WOMAC and VAS pain scores. Lower limb embolism was determined by ultrasonic scan and pulmonary embolism was diagnosed by clinical manifestation and D-dimer level. RESULTS: Sixty-nine patiets (138 knees) were followed up at 2 d preoperatively and the second day, 1, 2, 8 and 24 weeks postoperatively. The average postoperative WOMAC and VAS score were significantly lower than preoperative levels,while the postoperative knee ROM and 6 min walking distance were evidently higher than the preoperative ones, respectively. One hundred and twenty-eight knees achieved full extension and flexion more than 90 degree at 2 weeks postoperatively, and 135 knees reached 110 degree in flexion. Unilateral lower limb embolism was found in 2 cases (2 knees) and bilateral ones were found in 1 case (2 knees). No pulmonary embolism was confirmed. CONCLUSION: Rehabilitation protocols should be made for preoperative, early postoperative and late postoperative stages of simultaneous bilateral knee arthroplasty. Patients should be encouraged to exercise at the early postoperative stage on the premise of multimodal analgesia, in order to improve knee function and reduce edema.

[Prognostic significance of hidden blood loss in total hip arthroplasty (THA)].

OBJECTIVE: To explore the prognostic significance of hidden blood loss in total hip arthroplasty. METHODS: From May 2008 to July 2009, Harris hip score was used to evaluate the functions of 71 patients undergoing single side total hip arthroplasty (including 47 males and 24 females with a mean age of 68.3 years, ranged from 48 to 75 years). The blood loss in the operation was analyzed to study the correlation between hidden blood loss and the functional rehabilitation. RESULTS: All 71 patients undergoing THA were involved in the result analysis. The mean total blood loss was 1473 ml and the hidden blood loss was 545 ml (37%). Hidden blood loss significantly correlated with functional rehabilitation (P = 0.001), but there were no correlations between functional rehabilitation and age, gender, operative limb of patients (P = 0.067, 0.527, 0.926, 0.072). CONCLUSION: Hidden blood loss maybe a useful prognostic information contributing to the functional rehabilitation of total hip arthroplasty.

[Complications of bipolar hemiarthroplasty for the treatment of unstable intertrochanteric fractures in the elderly].

OBJECTIVE: To analyze the complications of bipolar hemiarthroplasty for the treatment of intertrochanteric fractures. METHODS: From Jan. 2004 to Dec. 2007, 62 patients over 80 years old with unstable interthochanteric fracture were treated with bipolar hemiarthroplasty, included 34 males and 28 females with an average age of 86.3 years ranging from 81 to 97 years. According to the Evans classification, there were 29 cases of Evans III, 26 of Evans IV and 7 of Evans V. The systemic and operation related complications were investigated. RESULTS: Among all the cases, 59 were followed up in outpatient department for 24 to 70 months (33 months on average). Systemic complications were found in 19 cases with no death during preoperative period and 5 deaths after leaving hospital. Operation related complications were found in 9 cases, included 3 cases of thigh pain, 1 iatrogenic fracture of proximal femur, 2 hip dislocations, 2 delayed union of fractures and 1 superficial infection. There were no aseptic loosening, peri-prosthetic infections,ectopic ossification or injuries of nerves and vessels. CONCLUSION: Bipolar hemiarthroplasty is indicated for patients over 80 years old with intertrochanteric fracture, thus the organic or systemic malfunctions should be corrected during perioperative period. Meanwhile, retaining of lesser trochanter and reconstruction of calcar femorale are important for improving periprosthetic biomechanics and reducing local complications.

[Concentration measurement of the OPG and sRANKL of peripheral blood among normal healthy people].

OBJECTIVE: To measure the concentration of osteoprotegerin (OPG) and receptor activator of NF-kappaB ligand (sRANKL) in peripheral blood among normal healthy people and investigate the relationship pf the concentration with age and sex. METHODS: The peripheral blood samples of 220 normal healthy people (included 108 males and 112 females, aged from 35 to 70) were collected in the morning. The OPG and sRANKL concentration of blood serum were measured by ELISA. RESULTS: The concentrations in female peripheral blood were: OPG 21.95 to 315.47 pg/ml, sRANKL 10.25 to 370.20 pmol/L; while in male were: OPG 14.78 to 192.55 pg/ml, sRANKL 9.22 to 300.32 pmol/L. There was positive correlation between the OPG concentration and age in the females older than 46 years. And for female older than 57, the sRANKL concentration of peripheral blood increases obviously. CONCLUSION: Age and sex are the elements that affect the OPG and sRANKL concentration in peripheral blood. For female older than 46, the OPG concentration of peripheral blood increases with age, while the sRANKL concentration of peripheral blood increases for females older than 57.