Does the use of intraoperative measurement reduce limb length discrepancies after total hip arthroplasty?

PURPOSE: Postoperative limb length discrepancy (LLD) is a common complication of total hip arthroplasty, and several methods exist to prevent LLD, but each has its benefits and drawbacks. The study investigates the application of intraoperative lower limb length measurement in preventing postoperative LLD. METHODS: This study retrospectively analyzed 70 patients who underwent total hip arthroplasty from October 2018 to July 2022. The length of the lower limb on the operated side was measured intraoperatively using a sterilized paper ruler after the fitting of the trial mould and compared with the healthy side. Then the prosthesis size, depth and neck length were adjusted accordingly. RESULTS: The absolute value of postoperative LLD was found to be 6.68 ± 4.48 mm, of which 53 cases (75.7%) were less than or equal to 10 mm, while 30 patients (42.9%) were less than or equal to 5 mm. CONCLUSION: The use of intraoperative measurement is effective in reducing LLD after total hip arthroplasty.

Repression of let-7b-5p prevents the development of multifidus muscle dysfunction by promoting vitamin D accumulation via upregulation of electron transfer flavoprotein alpha subunit in a rat model of multifidus muscle injury.

Multifidus muscle dysfunction is associated with the multifidus muscle injury (MMI), which ultimately result in the low-back pain. Increasing evidence shows that microRNAs (miRs) may be involved in multifidus muscle dysfunction. In this study, we tested the hypothesis that downregulation of let-7b-5p may inhibit the multifidus muscle dysfunction development and progression. The target prediction program and luciferase activity determination confirmed electron transfer flavoprotein alpha subunit (ETFA) as a direct target gene of let-7b-5p. To study the mechanisms and functions of let-7b-5p in relation to ETFA in MMI progression, we prepared rats with experimental MMI, and a lentivirus-based packaging system was designed to upregulate expressions of let-7b-5p, and downregulate the expression of ETFA. ETFA was identified as a target gene of let-7b-5p. Older age, a longer duration of pain, and higher visual analog scale and Oswestry disability index scores for the patients with chronic low-back pain were linked to a more severe degree of degenerative muscle atrophy and fatty infiltration. Increased expression of let-7b-5p and decreased expression of ETFA and vitamin D receptor (VDR) were positively correlated with multifidus muscle dysfunction. Downregulated let-7b-5p could inhibit infiltration of collagen fibers, reverse the ultrastructural changes of multifidus muscle, and induce the VDR expression, thereby repair the MMI. The results provided a potential basis for let-7b-5p that could support targeted intervention in multifidus muscle dysfunction. Collectively, this study confirmed that downregulation of let-7b-5p has a potential inhibitory effect on the development of the function of the musculus myocytes by upregulating ETFA.

LncRNA DLX6-AS1/miR-129-5p/DLK1 axis aggravates stemness of osteosarcoma through Wnt signaling.

Osteosarcoma is the most common primary bone tumor and occurs most frequently in adolescents. Cancer stem cells (CSCs) are resistant to chemotherapy and radiotherapy, and can drive cancer recurrence. In this study, we aimed to investigate the effect of Long noncoding RNAs (lncRNAs) DLX6-AS1 on osteosarcoma stemness and the underlying mechanism involved. DLX6-AS1 enhanced osteosarcoma stemness in vitro and in vivo. Moreover, DLX6-AS1 competitively interacted with miR-129-5p to DLK1, resulting in activation of Wnt signaling and promotion of stemness in osteosarcoma. DLX6-AS1 functionally interplayed with miR-129-5p to form a reciprocal feedback loop to activate Wnt signaling. High DLX6-AS1 expression was observed in osteosarcoma tissues, and predicted a poor prognosis for osteosarcoma patients. Our study suggests that DLX6-AS1, combined with miR-129-5p and DLK1, can be utilized as factors for the clinical diagnosis and prognosis of osteosarcoma, and may be potential targets for the treatment of osteosarcoma.

Association of IFNG gene polymorphisms with pulmonary tuberculosis but not with spinal tuberculosis in a Chinese Han population.

Spinal tuberculosis (STB) is an extrapulmonary form of tuberculosis (TB) caused by Mycobacterium tuberculosis (Mtb), which accounts for around 2% of all TB cases and can lead to spine degeneration. It is widely accepted that host genetic factors participate in the pathogenesis of active TB, but the factors controlling which TB form will manifest after Mtb infection remain unknown. We hypothesized that a genetic difference may exist between the development of STB and pulmonary tuberculosis (PTB). Here, three single nucleotide polymorphisms (SNPs) in the IFNG gene (rs2069718), IRGM gene (rs10065172), and MBL2 gene (rs11003125) were genotyped among 183 PTB patients, 177 STB patients, and 360 healthy controls from the Chinese Han population. We found that rs2069718 genotypes were significantly associated with PTB (TT, p = 0.007; CT, p = 0.008) but not STB, and the TT genotype (p = 0.046) of rs2069718 were less common in PTB than in STB. In contrast, neither PTB nor STB were found to be associated with rs10065172 and rs11003125. Overall, we found a difference in the rs2069718 genetic distribution between the STB and PTB patients in a Chinese Han population. The rs2069718 TT genotype was associated with a protective role in PTB but not STB development during active Mtb infection.

Transforming Natural Eggshell and Diatomite into Bioactive Calcium Silicate Material for Bone Regeneration.

Calcium silicate (CS), a new and important bioceramic bone graft material, is prepared by using eggshells, which have a porous structure and are rich in calcium ions. Furthermore, the preparation of new CS materials using eggshells and diatomaceous earth minimizes their negative impact on the environment. In this study, we prepared CS materials using a high-temperature calcination method. The composition of the material was demonstrated by X-ray diffraction (XRD) and Fourier transform infrared spectroscopy (FTIR) analysis. Scanning electron microscopy (SEM) analysis confirmed the porous structure of the CS material. We also introduced ZnO to prepare ZnO-CS with antibacterial properties and showed that ZnO-CS exhibits excellent antibacterial effects through in vitro antibacterial experiments. Subsequent in vitro mineralization experiments demonstrated that ZnO-CS promoted the formation of a hydroxyapatite layer. Furthermore, in vitro cytotoxicity experiments demonstrated that ZnO-CS had very good biosafety and promoted cell proliferation. These findings were confirmed through subsequent cell proliferation experiments. Our results indicate that the novel ZnO-CS is a promising candidate for bone tissue engineering.

Lumbar Sympathetic Trunk Injury: An Underestimated Complication of Oblique Lateral Interbody Fusion.

OBJECTIVE: Lumbar sympathetic trunk (LST) injury is one of the major complications after oblique lumbar interbody fusion (OLIF). LST injury often manifests as unequal skin temperature in lower limbs after operation, and there may be a large number of missed diagnoses due to the lack of attention and different diagnostic methods. The study aimed to investigate the incidence and clinical characteristics of LST injury after OLIF. METHODS: The data of patients with lumbar degenerative diseases who underwent OLIF in our hospital from April 2016 to October 2017 were retrospectively analyzed. Finally, a total of 54 patients were included. There were 10 males and 44 females, aged 58.4 ± 10.9 years. The skin temperature of lower limbs was measured before and a day after surgery. The patients were followed up at 1 week, 6 weeks, 6 months, and 2 years after the surgery. Likert five-point scale was used to evaluate the discomfort caused by LST injury. Injury severity score was introduced to grade injury degree according to the recovery time of postoperative symptoms. The chi-square test was used to analyze the association of incidence of lumbar sympathetic trunk (LST) injury with contributing factors, such as gender and number of surgical segments. RESULTS: The unequal temperature was not found before surgery in all the patients. Postoperatively, 16 cases (29.6%) had difference of skin temperature more than 0.5 °C and were diagnosed with LST injury. Eight patients (14.8%) had self-perception of skin temperature differences, and 12 patients (22.2%) had other symptoms, such as muscle pain, numbness, and weakness, which were not statistically different between patients with and without lumbar sympathetic trunk injury (p > 0.05). In the 16 patients with LST injury, the difference of skin temperature between the two legs was 0.6 ± 0.1 °C on the first day, and the temperature difference lasted for 1.5-~12 months. According to Likert five-point scale, two cases (12.5%) were poor, and 14 cases (87.5%) were moderate immediately after surgery. Fifteen cases improved to some extent 6 weeks to 12 months after surgery. CONCLUSION: Postoperative LST injury is mainly manifested by different temperature of lower limbs. The incidence was higher in patients with multi-segment OLIF than in those with single-segment OLIF, and the subjective experience of most patients with LST injury was moderate discomfort.

[Single oblique lumbar interbody fusion with robot-assisted posterior internal fixation for lumbar degenerative diseases].

OBJECTIVE: To investigate the efficacy of single oblique lumbar interbody fusion(OLIF) with robot-assisted posterior internal fixation for the treatment of lumbar degenerative diseases. METHODS: The clinical data of 67 patients with lumbar degenerative diseases treated from September 2019 to December 2020 was retrospectively analyzed. According to different surgical methods, the patients were divided into traditional group and robot group. The traditional group received traditional OLIF with posterior fluoroscopy percutaneous nail fixation, and the robot group received OLIF with robot-assisted posterior internal fixation. There were 33 patients in traditional group, including 13 males and 20 females, aged from 44 to 82 years old with an average of (59.7±9.1) years; and 34 cases in robot group, including 7 males and 27 females, aged from 45 to 81 years old with an average of(61.6±8.8) years. The operation time, fluoroscopy time, intraoperative blood loss, postoperative out of bed time and hospital stay were recorded. The visual analogue scale (VAS) of low back pain and Oswestry Disability Index(ODI) were compared before operation and 3 days, 3 months after operation between two groups. The accuracy of nail placement was evaluated by postoperative CT scan. RESULTS: Both groups of patients successfully completed the operation and were followed up for more than 3 months. The operation time, fluoroscopy time, intraoperative blood loss, postoperative out of bed time and hospital stay in traditional group were(299.85±15.79) min, (62.58±10.83) min, (118.33±10.80) ml, (2.5±0.7) d, (9.67±2.13) d;and robot group was(248.53±14.22) min, (19.47±3.51) min, (115.74±9.86) ml, (2.3±0.6) d, (9.44±1.93) d, respectively. The symptoms of postoperative low back pain, lower limb pain and numbness were significantly improved in all patients. The operation time and fluoroscopy time in robot group were significantly less than those of traditional group. There was no significant difference in intraoperative blood loss, postoperative out of bed time, hospital stay, VAS and ODI before and after operation (P>0.05). The accuracy of nail placement in robot group was 98.8% (2/160), which was higher than 89.9% (16/158) in traditional group. CONCLUSION: Treatment of lumbar degenerative diseases with single body position OLIF with robot-assisted posterior minimally invasive internal fixation has less operation time and fluoroscopy time, high nail placement accuracy and accurate surgical effect, which is worthy to be popularized in clinic.

Meta-analysis of the risk of dementia in elderly patients with late-onset epilepsy.

Although available literature indicates a high risk of dementia in elderly patients with late-onset epilepsy (LOE), the findings are yet inconsistent and relevant risk factors are unclear, rendering rational clinical interpretation rather challenging. This article systematically evaluates the risk of dementia in elderly LOE patients. The potential risk factors were analyzed to provide a specific basis for clinical prediction of dementia. PubMed and web of science databases were searched for the published cohort studies of dementia in elderly LOE patients. The search results were subject to a meta-analysis with Stata16.0 statistical software. Seven articles were included for a comparison of dementia risk between epilepsy cases and controls, yielding a hazard ration (HR) of 2.1 (95 %CI：1.6～2.75，p = 0.00); dementia was more prevalent in female patients than in male counterparts, though without a statistical difference [1.2 % (95 %CI, 0.9 %-1.6 %) vs. 0.8 % (95 %CI, 0.5 %-1.1 %)]; compared with the non-LOE group, the LOE population reported a significantly higher incidence of diabetes mellitus [14.1 % (95 %CI, 12.8 %-15.4 %) vs. 10.9 % (95 %CI, 10.1 %-11 %), p < 0.01]. The findings suggest that elderly patients with late-onset epilepsy run a higher risk of dementia than non-epileptic patients and diabetes mellitus may serve as a potential risk factor for dementia in this elderly populace.

lncRNA TPTEP1 inhibits stemness and radioresistance of glioma through miR­106a­5p­mediated P38 MAPK signaling.

Glioma is diagnosed as the most common intracranial malignant tumor. Cancer stem cells determine stemness and radioresistance, and may facilitate glioma recurrence. The present study aimed to investigate whether the long non­coding RNA (lncRNA) transmembrane phosphatase with tensin homology pseudogene 1 (TPTEP1) regulated cell stemness and radioresistance of glioma, and determine the underlying molecular mechanism of TPTEP1 in the modulation of glioma progression. Cell and molecular biology techniques were applied for investigating the role of TPTEP1 in glioma cell lines, animal model, and clinical samples. The results demonstrated that TPTEP1 attenuated stemness and radioresistance of glioma both in vitro and in vivo. In addition, TPTEP1 augmented MAPK14 expression by competitively interacting with microRNA (miR)­106a­5p, thus activating the P38 MAPK signaling pathway, and suppressing glioma stemness and radioresistance. TPTEP1 functionally bound to miR­106a­5p, which formed a reciprocal regulatory loop to stimulate the P38 MAPK signaling pathway. Low TPTEP1 expression levels were detected in high­grade glioma tissues compared with low­grade glioma tissues, and were positively associated with poor prognosis of patients with glioma. Furthermore, analysis using data from The Cancer Genome Atlas database confirmed the molecular mechanism and biological significance of dysregulation of TPTEP1 in glioma progression. Taken together, the results of the present study suggest that TPTEP1 may be applied as a diagnostic and prognostic indicator for glioma, and may be an alternative target for the treatment of glioma.