[Accuracy and clinical efficacy of robot-assisted transiliac-transsacral screw placement for posterior pelvic ring fractures].

OBJECTIVE: To explore accuracy and clinical effect of robot-assisted implantation of sacroiliac penetrating screw in orthopedic surgery for posterior pelvic ring fracture. METHODS: The clinical data of 24 patients with posterior pelvic ring fracture treated with robot-assisted sacroiliac penetration screws from August 2022 to August 2023 were retrospectively analyzed, including 10 males and 14 females; aged from 21 to 73 years old with an average of (49.29±14.48) years old;according to Tile pelvic fractures, 13 patients were type B and 11 were type C. The effect of screw placement was evaluated according to Gras criteria based on postoperative CT scan results. At the final follow-up, fracture healing was evaluated according to Matta score, and functional recovery was evaluated by Majeed score. RESULTS: All patients were followed up for 3 to 13 months with an average of (6.00±3.28) months. Totally 36 sacroiliac penetrating screws, 18 S1 penetrating screws, 18 S2 penetrating screws were inserted, a total of 29 were excellent and 7 good according to Gras standard. Screw adjustment times was 0.00 (0.00, 0.75) times. At the final follow-up, Matta score was excellent in 18 patients, 5 good and 1 moderate, and the maximum displacement distance was 2.55 (0.00, 5.65) mm. Majeed score was 84.37±8.38, 15 patients were excellent, 7 good and 2 moderate. CONCLUSION: Robot could accurately and safely assist in the placement of sacroiliac joint screws for the treatment of posterior pelvic ring fractures, and promote postoperative functional recovery of patients.

[Hip joint biomechanical analysis of the acetabular anatomical reconstruction and nonanatomical reconstruction in total hip arthroplasty for Crowe type â ¢ developmental dysplasia of the hip by finite element method].

OBJECTIVE: To analyze the hip joint biomechanics of the acetabular anatomical reconstruction and nonanatomical reconstruction in total hip arthroplasty (THA) for Crowe type Ⅲ developmental dysplasia of the hip (DDH) by finite element method, which provided theoretical foundation and experimental basis for the anatomical acetabular reconstruction during THA in clinical practice. METHODS: One patient with left end-stage hip arthritis secondary to Crowe type Ⅲ DDH was selected in this study, who underwent total hip arthroplasty in the orthopedic department of the First Affiliated Hospital of Bengbu Medical College in April 2020. This patient was female, 57 years old. The preoperative and postoperative three dimentional CT scan of the patient's pelvis were performed. Fourteen acetabular cup models with different anteversion, inclination and rotation center height were established in Mimics and 3-Matic software. The boundary and load conditions were set in Abaqus software. The Von Mises and stress distribution of the hip joint were calculated and observed. RESULTS: In the Crowe type Ⅲ DDH THA, if the hip rotation center was restored anatomically and the acetabular cup's inclination was set as 40°, the cup's anteversion varied from 5° to 25°, the lowest Von Mises value of acetabular cup and polyethylene liner occured in 20°anteversioin;if the hip rotation center was restored anatomically and the acetabular cup's anteversion was set as 15°, the cup's inclination varied from 35° to 55°, the lowest Von Mises value of acetabular cup and polyethylene liner occured in 35° inclination;if the acetabular cup's anteversion and inclination were set as 15°and 40°respectively, the up migration of hip rotaion center varied from 0 mm to 20 mm, the lowest Von Mises value of acetabular cup and polyethylene liner occured in 10 mm up migration. In all fourteen models, the Von Mises value of the acetabulum, acetabulum cup and polyethylene liner were lowest when the acetabular cup's anteversion and inlcination were 15°, 35° respectively, as well as the rotation center was restored anatomically. CONCLUSION: In total hip arthroplasty for Crowe type Ⅲ DDH, the anatomical restoration of hip rotation center with 15° anteversion and 35° inclination of the acetabular cup are suggested, bone graft above the acetabular cup and additional screws are recommended simultaneously to further reduce the Von Mises of hip joint.

Influence of Posterior Spinal Surgery Drainage on Hematoma and Infections at Surgical Sites: A Systematic Review and Meta-Analysis.

Objective: The primary objective of this systematic review and meta-analysis was to assess the effectiveness of postoperative drainage in reducing the incidence of Surgical Site Hemorrhage (SSH) and Surgical Site Infections (SSI) in patients undergoing posterior spinal surgery. Methods: We conducted a comprehensive search of four electronic databases, including PubMed, Embase, Web of Science, and Cochrane Library, to identify relevant studies. Only Randomized Controlled Trials (RCT) focusing on patients diagnosed preoperatively with non-infectious spinal diseases and undergoing posterior spinal surgery were included. The meta-analysis examined the efficacy of postoperative drainage in reducing SSH and SSI incidence. Quality assessment was performed using the Cochrane Collaboration's Risk of Bias tool. Statistical analyses were conducted to evaluate heterogeneity and publication bias. Results: A total of seven studies met the inclusion criteria for SSH analysis, while six studies were included in the SSI analysis. The findings revealed a significant reduction in the incidence of SSH in patients with postoperative drainage, with a Relative Risk (RR) of 0.35 (95% CI: 0.20 to 0.62, P < .01). However, no statistically significant impact was observed on the incidence of SSI (RR: 0.97, 95% CI: 0.36 to 2.59, P = .81). Funnel plot symmetry and Egger's linear regression test confirmed the absence of significant publication bias. Conclusions: The use of postoperative drainage in posterior spinal surgery is recommended to significantly reduce the risk of SSH. However, its effectiveness in preventing SSI remains inconclusive and requires further investigation. These can inform clinical decision-making and potentially improve patient outcomes.

[Application and research progress of artificial intelligence technology in trauma treatment].

Objective: To review the application and research progress of artificial intelligence (AI) technology in trauma treatment. Methods: The recent research literature on the application of AI and related technologies in trauma treatment was reviewed and summarized in terms of prehospital assistance, in-hospital emergency care, and post-traumatic stress disorder risk regression prediction, meanwhile, the development trend of AI technology in trauma treatment were outlooked. Results: The AI technology can rapidly analyze and manage large amount of clinical data to help doctors identify patients' situation of trauma and predict the risk of possible complications more accurately. The application of AI technology in surgical assistance and robotic operations can achieve precise surgical plan and treatment, reduce surgical risks, and shorten the operation time, so as to improve the efficiency and long-term effectiveness of the trauma treatment. Conclusion: There is a promising future for the application of AI technology in the trauma treatment. However, it is still in the stage of exploration and development, and there are many difficulties of historical data bias, application condition limitations, as well as ethical and moral issues need to be solved.

Determining the orientation of acetabular prosthesis in total hip arthroplasty by refering to the anatomical landmarker of acetabular notches.

The aim of this study was to explore a novel method to determine the orientation of acetabular prosthesis in total hip arthroplasty (THA) by refering to the anatomical landmarker of acetabular notches. Forty-one normal developmental hips were included in the present study. The acetabulums were reamed according to standard surgical procedures of THA on life-size 3D printing pelvis models. The inferior edge of acetabular cup were placed (1-5) mm proximal and distal to the proximal line of the anterior and posterior acetabular notches (PLAPAN) respectively to determine cup inclination. The inferior edge of acetabular cup were placed (1-5) mm pronating and supinating around the proximal point of acetabular posterior notch (PPAPN) respectively to determine cup anteversion. The pelvis plain radiographs were took and the inclination and anteversion of the acetabular cup at 22 positions were calculated. In the normal developmental hip, the mean inclination of acetabular prothesis were (35.10 ± 3.22)° and (45.90 ± 2.68)° when the inferior edge of the acetabular cup was 3 mm proximal and 1 mm distal to the PLAPAN. The optimal cup inclination could be obtained when the inferior edge of the acetabular cup was 1 mm proximal to the PLAPAN (the mean inclination was (40.71 ± 2.80)°). The mean anteversion of acetabular prothesis were (10.67 ± 4.55)° and (20.86 ± 4.44)° when the inferior edge of the acetabular cup was 1 mm pronating and 1 mm supinating around the PPAPN. The optimal cup anteversion could be obtained when the inferior edge of the acetabular cup was parallel to the PLAPAN (the mean anteversion was (18.00 ± 1.64)°). The inclination and anteversion of acetabular prosthesis could be determined by refering the anatomical landmarks of acetabular notches, which could help orthopedists to install the acetabular prosthesis quickly and safely in THA.

Cysteine carboxyethylation generates neoantigens to induce HLA-restricted autoimmunity.

Autoimmune diseases such as ankylosing spondylitis (AS) can be driven by emerging neoantigens that disrupt immune tolerance. Here, we developed a workflow to profile posttranslational modifications involved in neoantigen formation. Using mass spectrometry, we identified a panel of cysteine residues differentially modified by carboxyethylation that required 3-hydroxypropionic acid to generate neoantigens in patients with AS. The lysosomal degradation of integrin αIIb [ITGA2B (CD41)] carboxyethylated at Cys96 (ITGA2B-ceC96) generated carboxyethylated peptides that were presented by HLA-DRB1*04 to stimulate CD4+ T cell responses and induce autoantibody production. Immunization of HLA-DR4 transgenic mice with the ITGA2B-ceC96 peptide promoted colitis and vertebral bone erosion. Thus, metabolite-induced cysteine carboxyethylation can give rise to pathogenic neoantigens that lead to autoreactive CD4+ T cell responses and autoantibody production in autoimmune diseases.

3D PRINTING APPLICATION IN BONE DEFECT AREA MEASUREMENT ON PATIENTS WITH DEVELOPMENTAL DYSPLASIA OF THE HIP.

Objectives: Evaluate the application value of 3D printing technology in measuring acetabular bone defect area in adult patients diagnosed with developmental dysplasia of the hip (DDH). Methods: 23 cases of DDH requiring total hip replacement surgery were enrolled in this study. Preoperative examination confirmed the standard pelvic plain films Crowe, including 3 cases of Crowe I, 7 Crowe II, and 13 Crowe III. The 3D printing technology was used to print the hip model before the operation. Based on the pre-printed model, pre-operative planning and surgical procedures were established. The area of the acetabular bone defects was measured, the selected size prosthesis was recorded, and the surgery was performed (group A). The actual acetabular bone defect area and the prosthesis size were also recorded (group B). Results: The comparative results indicated that the actual acetabular defect area measured intraoperatively and the area measured using the 3D printing technology did not significantly differ for all participants (all P>0.05). Conclusion: Preoperative model can accurately measure the acetabular bone defect area for DDH. It is significant to develop individualized implants for DDH patients treated with the 3D printing technique. Level of Evidence IV: Case series .

Objetivos: Avaliar o potencial da aplicação da tecnologia de impressão 3D na medição da área de defeito ósseo acetabular em pacientes adultos diagnosticados com displasia do desenvolvimento do quadril (DDH). Métodos: 23 casos de DDH que requereram cirurgia de substituição total do quadril foram incluídos neste estudo. O exame pré-operatório confirmou os filmes pélvicos padrão Crowe, incluindo 3 casos de Crowe I, 7 Crowe II, e 13 Crowe III. A tecnologia de impressão 3D foi utilizada para imprimir o modelo de quadril antes da operação. Com base no modelo pré-impresso, o planejamento pré-operatório e os procedimentos cirúrgicos foram estabelecidos. A área dos defeitos ósseos acetabulares foi medida, a prótese de tamanho selecionado foi registrada, e a cirurgia foi realizada (grupo A). A área do defeito ósseo acetabular real e o tamanho da prótese também foram registrados (grupo B). Resultados: Os resultados comparativos indicaram que a área real do defeito acetabular medida intraoperativamente e a área medida usando a tecnologia de impressão 3D não diferiu significativamente para todos os participantes (todos P>0,05). Conclusão: O modelo pré-operatório pode medir com precisão a área de defeito ósseo acetabular para DDH. É relevante desenvolver implantes individualizados para pacientes com DDH tratados com a técnica de impressão 3D. Nível de Evidência IV: Série de casos .

CD147 contributes to SARS-CoV-2-induced pulmonary fibrosis.

COVID-19 patients can develop clinical and histopathological features associated with fibrosis, but the pathogenesis of fibrosis remains poorly understood. CD147 has been identified as a universal receptor for SARS-CoV-2 and its variants, which could initiate COVID-19-related cytokine storm. Here, we systemically analyzed lung pathogenesis in SARS-CoV-2- and its delta variant-infected humanized CD147 transgenic mice. Histopathology and Transmission Electron Microscopy revealed inflammation, fibroblast expansion and pronounced fibrotic remodeling in SARS-CoV-2-infected lungs. Consistently, RNA-sequencing identified a set of fibrosis signature genes. Furthermore, we identified CD147 as a crucial regulator for fibroblast activation induced by SARS-CoV-2. We found conditional knockout of CD147 in fibroblast suppressed activation of fibroblasts, decreasing susceptibility to bleomycin-induced pulmonary fibrosis. Meplazumab, a CD147 antibody, was able to inhibit the accumulation of activated fibroblasts and the production of ECM proteins, thus alleviating the progression of pulmonary fibrosis caused by SARS-CoV-2. In conclusion, we demonstrated that CD147 contributed to SARS-CoV-2-triggered progressive pulmonary fibrosis and identified CD147 as a potential therapeutic target for treating patients with post-COVID-19 pulmonary fibrosis.

Restoring Rotation Center in Total Hip Arthroplasty for Developmental Dysplasia of the Hip with the Assistance of Three Dimensional Printing Technology: A Pilot Study.

OBJECTIVE: To develop a new method to restore hip rotation center exactly and rapidly in total hip arthroplasty (THA) with the assistance of three dimensional (3D) printing technology and evaluate its clinical and radiological outcomes. METHODS: From March 2014 to July 2018, a total of 17 patients (five hips of four men and 16 hips of 13 women) with end-stage osteoarthritis secondary to developmental dysplasia of the hip who underwent THA were analyzed and followed up retrospectively. The average age is 58.00 ± 8.12 years (range from 45 to 71 years). Simulated operations were performed on 3D printed hip models for preoperative planning. The morphology of Harris fossa and acetabular notches were recognized and restored to locate the acetabular center. The size of bone defect was measured by the bone wax method. The agreement on the size of acetabular cup and bone defect between simulated operations and actual operations were analyzed. Harris Hip Score (HHS) was used to evaluate the recovery of hip joint function. The vertical distance and horizontal distance of the rotation center on the pelvis plain radiograph were measured, which were used to assess the efficacy of restoring hip rotation center and acetabular cup migration. RESULTS: The mean sizes of bone defect in simulated operations and THA were 4.58 ± 2.47 cm2 and 4.55 ± 2.57 cm2 respectively. There was no significant difference statistically between the sizes of bone defect in simulated operations and the actual sizes of bone defect in THA (t = 0.03, P = 0.97). The sizes of the acetabular cup of simulated operations on 3D print models showed a high rate of coincidence with the actual sizes in the operations (ICC = 0.93). All 17 patients were available for clinical and radiological follow-up. The average follow-up time was 18.35 ± 6.86 months (range, 12-36 months. The average HHS of the patients was improved from (38.33 ± 6.07) preoperatively to the last follow-up (88.61 ± 3.44) postoperatively. The mean vertical and horizontal distances of hip rotation center on the pelvic radiographs were restored to 15.12 ± 1.25 mm and 32.49 ± 2.83 mm respectively. No case presented dislocation or radiological signs of loosening until last follow-up. CONCLUSIONS: The application of 3D printing technology facilitates orthopedists to recognize the morphology of Harris fossa and acetabular notches, locate the acetabular center and restore the hip rotation center rapidly and accurately.

Prophylactic abdominal drainage following appendectomy for complicated appendicitis: A meta-analysis.

Background: To date, the value of prophylactic abdominal drainage (AD) following appendectomy in patients with complicated appendicitis (CA), including adults and children, has yet to be determined. This paper presents a meta-analysis of the effects of prophylactic AD on postoperative complications in patients with CA, with the goal of exploring the safety and effectiveness of prophylactic AD. Methods: PubMed, Science Direct, Web of Science, Cochrane Library, and Embase databases were searched for relevant articles published before August 1, 2022. The primary outcomes were the complication rates [overall incidence of postoperative complications, incidence of intra-abdominal abscess (IAA), wound infection (WI), and postoperative ileus (PI), and the secondary outcome was the perioperative outcome]. The meta-analysis was performed with STATA V. 16.0A. Results: A total of 2,627 articles were retrieved and 15 high-quality articles were eventually included after screening, resulting in a total of 5,123 patients, of whom 1,796 received AD and 3,327 did not. The results of this meta-analysis showed that compared with patients in the non-drainage group, patients in the drainage group had longer postoperative length of hospitalization (LOH) (SMD = 0.68, 95% CI: 0.01-1.35, P = 0.046), higher overall incidence of postoperative complications (OR = 0.50, 95% CI: 0.19-0.81, P = 0.01), higher incidence of WI (OR = 0.30, 95% CI: 0.08-0.51, P = 0.01) and PI (OR = 1.05, 95% CI: 0.57-1.54, P = 0.01), the differences were statistically significant. However, there was no significant difference in the incidence of IAA (OR = 0.10, 95% CI: -0.10 to 0.31, P = 0.31) between the two groups. The results of subgroup meta-analysis showed that in the adult subgroup, the overall incidence of postoperative complications in the drainage group was higher than that in the non-drainage group (OR = 0.67, 95% CI: 0.37-0.96, P = 0.01). However, there were no significant differences in IAA (OR = 0.18, 95% CI: -0.28 to 0.64, P = 0.45) and WI (OR = 0.13, 95% CI: (-0.40 to 0.66, P = 0.63) and PI (OR = 2.71, 95% CI: -0.29 to 5.71, P = 0.08). In the children subgroup, there were no significant differences in the incidence of IAA (OR = 0.51, 95% CI: -0.06 to 1.09, P = 0.08) between the two groups. The overall incidence of postoperative complications (OR = 0.46, 95% CI: 0.02-0.90, P = 0.04), incidences of WI (OR = 0.43, 95% CI: 0.14-0.71, P = 0.01) and PI (OR = 0.75, 95% CI: 0.10-1.39, P = 0.02) were significantly higher than those in the non-drainage group. Conclusion: This meta-analysis concluded that prophylactic AD did not benefit from appendectomy, but increased the incidence of related complications, especially in children with CA. Thus, there is insufficient evidence to support the routine use of prophylactic AD following appendectomy.

3d printing application in bone defect area measurement on patients with developmental dysplasia of the hip / Aplicação de impressão 3d na mensuração da área de defeitos ósseos em pacientes com displasia do desenvolvimento do quadril

ABSTRACT Objectives Evaluate the application value of 3D printing technology in measuring acetabular bone defect area in adult patients diagnosed with developmental dysplasia of the hip (DDH). Methods 23 cases of DDH requiring total hip replacement surgery were enrolled in this study. Preoperative examination confirmed the standard pelvic plain films Crowe, including 3 cases of Crowe I, 7 Crowe II, and 13 Crowe III. The 3D printing technology was used to print the hip model before the operation. Based on the pre-printed model, pre-operative planning and surgical procedures were established. The area of the acetabular bone defects was measured, the selected size prosthesis was recorded, and the surgery was performed (group A). The actual acetabular bone defect area and the prosthesis size were also recorded (group B). Results The comparative results indicated that the actual acetabular defect area measured intraoperatively and the area measured using the 3D printing technology did not significantly differ for all participants (all P>0.05). Conclusion Preoperative model can accurately measure the acetabular bone defect area for DDH. It is significant to develop individualized implants for DDH patients treated with the 3D printing technique. Level of Evidence IV: Case series.

RESUMO Objetivos Avaliar o potencial da aplicação da tecnologia de impressão 3D na medição da área de defeito ósseo acetabular em pacientes adultos diagnosticados com displasia do desenvolvimento do quadril (DDH). Métodos 23 casos de DDH que requereram cirurgia de substituição total do quadril foram incluídos neste estudo. O exame pré-operatório confirmou os filmes pélvicos padrão Crowe, incluindo 3 casos de Crowe I, 7 Crowe II, e 13 Crowe III. A tecnologia de impressão 3D foi utilizada para imprimir o modelo de quadril antes da operação. Com base no modelo pré-impresso, o planejamento pré-operatório e os procedimentos cirúrgicos foram estabelecidos. A área dos defeitos ósseos acetabulares foi medida, a prótese de tamanho selecionado foi registrada, e a cirurgia foi realizada (grupo A). A área do defeito ósseo acetabular real e o tamanho da prótese também foram registrados (grupo B). Resultados Os resultados comparativos indicaram que a área real do defeito acetabular medida intraoperativamente e a área medida usando a tecnologia de impressão 3D não diferiu significativamente para todos os participantes (todos P>0,05). Conclusão O modelo pré-operatório pode medir com precisão a área de defeito ósseo acetabular para DDH. É relevante desenvolver implantes individualizados para pacientes com DDH tratados com a técnica de impressão 3D. Nível de Evidência IV: Série de casos.

Safety and efficacy of meplazumab in healthy volunteers and COVID-19 patients: a randomized phase 1 and an exploratory phase 2 trial.

Recent evidence suggests that CD147 serves as a novel receptor for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Blocking CD147 via anti-CD147 antibody could suppress the in vitro SARS-CoV-2 replication. Meplazumab is a humanized anti-CD147 IgG2 monoclonal antibody, which may effectively prevent SARS-CoV-2 infection in coronavirus disease 2019 (COVID-19) patients. Here, we conducted a randomized, double-blinded, placebo-controlled phase 1 trial to evaluate the safety, tolerability, and pharmacokinetics of meplazumab in healthy subjects, and an open-labeled, concurrent controlled add-on exploratory phase 2 study to determine the efficacy in COVID-19 patients. In phase 1 study, 59 subjects were enrolled and assigned to eight cohorts, and no serious treatment-emergent adverse event (TEAE) or TEAE grade ≥3 was observed. The serum and peripheral blood Cmax and area under the curve showed non-linear pharmacokinetic characteristics. No obvious relation between the incidence or titer of positive anti-drug antibody and dosage was observed in each cohort. The biodistribution study indicated that meplazumab reached lung tissue and maintained >14 days stable with the lung tissue/cardiac blood-pool ratio ranging from 0.41 to 0.32. In the exploratory phase 2 study, 17 COVID-19 patients were enrolled, and 11 hospitalized patients were involved as concurrent control. The meplazumab treatment significantly improved the discharged (P = 0.005) and case severity (P = 0.021), and reduced the time to virus negative (P = 0.045) in comparison to the control group. These results show a sound safety and tolerance of meplazumab in healthy volunteers and suggest that meplazumab could accelerate the recovery of patients from COVID-19 pneumonia with a favorable safety profile.

Large pulmonary cavity in COVID-19 cured patient case report.

Coronavirus Disease 2019 (COVID-19) is a pneumonia caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The outbreak began in Wuhan, China, and spread rapidly, with many cases confirmed in multiple countries. Usually, after viral pneumonia were clinical cured, the pulmonary lesions of majority patients will gradually be absorbed to complete dissipation, very few severe patients may retain pulmonary interstitial inflammation and fibrosis. In this case, we described one unique COVID-19 patient, the symptoms were: dry cough, fatigue, poor appetite and subjective fever, moreover, the patient was a non-smoker, had no pulmonary bullous, no history of tuberculosis, and also no hypertension or diabetes. The patient received antiviral therapy, antibacterial therapy, recombinant human interferon-α2a, vitamin C and oxygen inhalation. After two weeks of treatment and observation, the patient was clinical cured and discharged. However, two days later, the patient had a sudden chest stuffiness, CT images indicted: his lung didn't heal like others, but developed a large pulmonary cavity in the lower lobe of right lung. In hospital, the patient showed no symptoms of infection for another 14 days, and the pulmonary cavity remain unchanged. This case suggested: it is important to follow convalescent COVID-19 patients, especially their lung CT images, to make sure a fully recovery.

Novel 3D printed integral customized acetabular prosthesis for anatomical rotation center restoration in hip arthroplasty for developmental dysplasia of the hip crowe type III: A Case Report.

RATIONALE: Exact restoration of the rotation center in total hip arthroplasty (THA) is technically challenging in patients with end-stage osteoarthritis due to developmental dysplasia of the hip (DDH), especially in the Crowe type II and III procedures. The technical difficulty is attributable to the complex acetabular changes. In this study, a novel 3-dimensional (3D) printed integral customized acetabular prosthesis for anatomical rotation restoration in THA for DDH Crowe type III was developed using patient-specific Computer-aided design and additive manufacturing (AM) methods. PATIENT CONCERNS: A 69-year-old female patient had developed left hip joint pain and restricted movement for 40 years; the symptoms had increased in the past 5 months. Pain, limited motion of the left hip joint, and lower limb length discrepancy were noted during physical examination. DIAGNOSIS: The patient was diagnosed with left hip end-stage osteoarthritis secondary to DDH (Crowe type III). INTERVENTION: A 3D printed acetabulum model was manufactured and a simulated operation was performed to improve the accuracy of reconstruction of the rotation center and bone defect. A 3D printed titanium alloy integral customized acetabular prosthesis was designed according to the result of simulated operation. The integral customized prothesis was implanted subsequently via the posterolateral approach. Radiography of the pelvis and Harris score assessment were performed during the perioperative period as well as at the 6- and 12-month follow-up. OUTCOMES: The 3D printed integral customized acetabular prosthesis matched precisely with the reamed acetabulum. The rotation center was restored and the bone defect was exactly reconstructed. There were no signs of prosthetic loosening at the 12-month follow-up. The Harris score gradually improved during the follow-up period. LESSONS: Satisfactory results of hip rotation restoration and bone defect reconstruction could be achieved by using 3D printed integral customized acetabular prosthesis, which provides a promising way to reconstruct the acetabulum in patients with DDH anatomically and rapidly for THA.

[Effect of vascularized peroneus longus tendon graft reconstruction on anterior cruciate ligament insertion in rabbits].

OBJECTIVE: To investigate the effect of vascularized peroneus longus tendon graft reconstruction on anterior cruciate ligament (ACL) insertion in rabbits. METHODS: Eighty healthy New Zealand white rabbits were harvested to prepare ACL injury models and randomly divided into two groups ( n=40). The ACL was reconstructed with vascularized peroneus longus tendon graft in group A and peroneus longus tendon graft without blood supply in group B. The survival of animals and the healing of incision were observed after operation; the grafts were taken for gross and histological observations at 4, 8, and 16 weeks; the biomechanical test of the grafts was carried out to record the maximum tensile strength and incidence of ACL insertion rupture at 8 and 16 weeks. RESULTS: All animals survived until the experiment completed. General observation showed that the tunnel was combined with grafts, the vascular infiltration was abundant, and no obvious boundary between the tunnel and grafts existed at 16 weeks in group A; there was still an obvious boundary between the tunnel and graft in group B. Histological observation showed that the collagen fibers between tendon and bone in group A increased gradually, the dense fiber connection was formed, and the "tidal-line" like structure similar to the normal ACL insertion was formed at 16 weeks; but the"tidal-line" like structure was not obvious in group B. Biomechanical test showed that there was no significant difference in the incidence of ACL insertion rupture at 8 and 16 weeks between group A and group B ( P=0.680; P=0.590), but the maximum tensile strength at 8 and 16 weeks were higher in group A than in group B ( t=18.503, P=0.001; t=25.391, P=0.001). CONCLUSION: The vascularized peroneus longus tendon graft for ACL reconstruction can obviously promote the outcome of the ACL insertion.

Mid-term and long-term results of restoring rotation center in revision hip arthroplasty.

BACKGROUND: To restore rotation center exactly in revision hip arthroplasty is technically challenging, especially in Paprosky type III. The technical difficulty is attributable to the complicated acetabular bone defect. In this study, we discussed the method of restoring rotation center in revision hip arthroplasty and reported the clinical and radiological outcome of mid-term and long-term follow-up. METHODS: This study retrospectively reviewed 45 patients (48 hips) who underwent revision hip arthroplasty, in which 35 cases (35 hips) were available for complete follow-up data. During the operation, the acetabular bone defect was reconstructed by impaction morselized bone graft, and the hip rotation center was restored by using remnant Harris fossa and acetabular notches as the marks. The clinical outcome was assessed using the Harris hip score. Pelvis plain x-ray was used to assess implant migration, stability of implants, and incorporation of the bone graft to host bone. RESULT: The average follow-up duration was 97.60 months (range 72-168 months). The average Harris hip score improved from 29.54 ± 10.87 preoperatively to 83.77 ± 5.78 at the last follow-up. The vertical distance of hip rotation center measured on pelvis x-ray was restored to normal, with the mean distance (15.24 ± 1.31) mm (range 12.4~17.3 mm). The mean loss of vertical distance of hip rotation center was (2.21 ± 0.72) mm (range 1.1 ~ 5.3 mm) at the last follow-up. CONCLUSION: Satisfactory clinical and radiological outcome can be obtained through restoring hip rotation center by using remnant Harris fossa and acetabular notches as the anatomical marks in revision hip arthroplasty.

How to restore rotation center in total hip arthroplasty for developmental dysplasia of the hip by recognizing the pathomorphology of acetabulum and Harris fossa?

PURPOSE: To restore rotation center exactly in total hip arthroplasty (THA) is technically challenging for patients with end-stage osteoarthritis due to developmental dysplasia of the hip (DDH). The technical difficulty is attributable to the complex acetabular changes. In this study, we investigated the pathomorphology of acetabulum and Harris fossa of Crowe types I to IV and discussed the method of restoring rotation center of the hip. METHODS: This study retrospectively reviewed 56 patients (59 hips) who underwent cementless THA due to end-stage osteoarthritis of DDH. The pathomorphology of acetabulum and Harris fossa was observed during operations. Using the preoperative and postoperative pelvic radiographs, the vertical and the horizontal distances of hip rotation center were measured in order to evaluate the effects of restoring rotation center of the hip. RESULTS: Adult DDH acetabulum could be classified into four basic pathological types which include the shallow cup shape, the dish shape, the shell shape, and the triangular shape. Adult DDH Harris fossa could be classified into four pathological types, including the crack shape, the closed shape, the triangle shape, and the shallow shape, in accordance with the osteophyte coverage. The vertical and horizontal distances of hip rotation center on the pelvic radiographs before and after operations were as follows: the preoperative vertical distance of hip rotation center was (39.96 ± 5.65) mm, and the postoperative one was (13.83 ± 2.66) mm; the preoperative horizontal distance of hip rotation center was (42.15 ± 6.42) mm, and the postoperative one was (28.12 ± 4.56) mm. CONCLUSIONS: The acetabulum and Harris fossa can display different pathological types on account of different degrees of dislocation and osteophyte hyperplasia in the end-stage osteoarthritis of adult DDH. The hip rotation center can be accurately restored by locating the acetabular center with Harris fossa and acetabular notch as the marks.

Dual roles of glutathione S-transferase mu 1 in the development and metastasis of hepatocellular carcinoma.

PURPOSE: Reactive oxygen species (ROS) are implicated in carcinogenesis, and cellular antioxidant systems are important for detoxifying ROS and reversing oxidant-mediated modifications. Glutathione S-transferase mu (GSTM) belongs to a family of phase II detoxification enzymes that catalyze the conjugation of reduced glutathione (GSH) to a wide range of endogenous and exogenous electrophilic compounds. The genotype of GSTM1 was associated with the risk and prognosis of cancer in several meta-analyses. This study explored the function of GSTM1 in hepatocellular carcinoma (HCC). METHODS: Polymerase chain reaction (PCR) and western blotting (WB) were used to detect the levels of gene and protein expression. MTS assays, Transwell assays, and flow cytometry were used to explore the function of GSTM1 in vitro. The xenograft assay and tail vein injection model were used to explore the function of GSTM1 in vivo. RESULTS: The mRNA and protein expression of GSTM1 was downregulated in HCC, but the expression levels of GSTM1 were not correlated with patient survival time. In vitro, Transwell and doxorubicin (DOX)-induced apoptosis assays revealed that GSTM1 showed opposite functions in different HCC cell lines with varied TP53 genotype statuses. The overexpression of GSTM1 in the above cell lines led to a significant decrease in ROS and an increase in GSH concentration and TP53 levels, suggesting that the controversial role of GSTM1 resulted from the TP53 genotype of HCC cells. The overexpression of GSTM1 promoted cell migration and inhibited apoptosis in the MHCC-97H cell line (TP53, R249S), but inhibited cell migration and increased apoptosis in the SMMC-7721 cell line (TP53 wildtype). CONCLUSION: GSTM1 down-regulation may partially account for ROS-mediated oxidative damage and HCC carcinogenesis. GSTM1 also regulates tumor progression by disrupting the ROS-TP53 axis in HCC cells with different genetic backgrounds.

[Short term effect of total hip arthroplasty through direct anterior approach for the treatment of ankylosing spondylitis with hip flexion deformity].

OBJECTIVE: To investigate the short term clinical efficacy of direct anterior approach(DAA) total hip arthroplasty for the treatment of ankylosing spondylitis with hip flexion deformity. METHODS: From September 2014 to June 2017, 15 cases of ankylosing spondylitis with flexion deformity of the hip were treated with total hip arthroplasty through DAA approach including 12 males(17 hips) and 3 females(4 hips) with an average age of 34.4 years old ranging from 21 to 57 years old. Harris score system was used before and after operation to evaluate hip function, total hip activity and visual analogue scale (VAS) were used to evaluate the clinical efficacy. RESULTS: All 15 patients were followed up for an average of 26.2 months. In the operation, 1 case of great trochanter avulsion was given wire binding, and 1 case of linear split of the femur were given by wire binding. There were no hematoma, nerve injury and deep vein thrombosis of lower extremity. No prosthesis loosening and sinking were observed in the follow-up of X-ray film after operation. There was no heterotopic ossification after operation. After operation, 18 hips pain were relieved completely, and 3 hips pain were found when walking, which all satisfied with the daily life self-care requirements. Harris hip score, total hip motion and VAS score at 1 week after operation were significantly different from those before operation(P<0.05). There was no significant difference in the scores of HHS, total hip motion and VAS at 1, 6 months after operation(P>0.05). At the final follow-up, the Harris score was 91.2±5.3, the total hip mobility was (217.1±29.7)°, and the postoperative VAS pain score was 1.2±0.5, which was significantly different from the preoperative score(P<0.05). CONCLUSIONS: DAA approach THA has good effect in treating AS hip nonfunctional ankylosis with less trauma, less pain and quick recovery. It has a good short term effect, which can effectively improve the quality of life of patients.

Mir-382 Promotes Differentiation of Rat Liver Progenitor Cell WB-F344 by Targeting Ezh2.

BACKGROUND/AIMS: Liver progenitor cells (LPCs) were considered as a promising hepatocyte source of cell therapy for liver disease due to their self-renewal and differentiation capacities, while little is known about the mechanism of LPC differentiate into hepatocytes. This study aims to explore the effect of miR-382, a member of Dlk1-Dio3 microRNA cluster, during hepatic differentiation from LPCs. METHODS: In this study, we used rat liver progenitor cell WB-F344 as LPC cell model and HGF as inducer to simulate the process of LPCs hepatic differentiation, then microRNAs were quantified by qPCR. Next, WB-F344 cell was transfected with miR-382 mimics, then hepatocyte cell trait was characterized by multiple experiments, including that periodic acid schiff staining and cellular uptake and excretion of indocyanine green to evaluate the hepatocellular function, qPCR and Western Blotting analysis to detect the hepatocyte-specific markers (ALB, Ttr, Apo E and AFP) and transmission electron microscopy to observe the hepatocellular morphology. Moreover, Luciferase reporter assay was used to determine whether Ezh2 is the direct target of miR-382. RESULTS: We found that miR-382 increased gradually and was inversely correlated with the potential target, Ezh2, during WB-F344 hepatic differentiation. In addition, functional studies indicated that miR-382 increased the level of hepatocyte-specific genes. CONCLUSIONS: This study demonstrates that miR-382 may be a novel regulator of LPCs differentiation by targeting Ezh2.