[Management algorithm for septic arthritis after anterior cruciate ligament reconstruction].

OBJECTIVE: To summarize the experience in the diagnosis and management of septic arthritis after anterior cruciate ligament reconstruction. METHODS: A retrospective review was conducted of all the arthroscopic anterior cruciate ligament reconstructions performed at Department of Sports Medicine, Peking University Third Hospital between January 2001 and December 2020. In the study, 65 of 27 867 patients experienced postoperative septic arthritis. The incidence, presentation, laboratory results, treatment, and outcome of all the infected patients were analyzed. The experiences of diagnosis and management of septic arthritis after anterior cruciate ligament reconstruction were summarized. RESULTS: A total of 27 867 anterior cruciate ligament reconstructions were performed at our department between January 2001 and December 2020. In the study, 65 (0.23%) patients were identified with postoperative septic arthritis. The most common symptoms of the infected patients were fever (38.7±0.5) ℃, knee swelling, pain, and restricted motion. The mean peripheral white blood cell count (WBC) was (9.2±2.6)×109/L (range 4.2×109/L-19.4×109/L), with (72.5±6.3) % (range 54.9%-85.1%) polymorphonuclear neutrophils (N). The mean erythrocyte sedimentation rate (ESR) was (59.9±24.1) mm/h (range 9-108 mm/h), C-reactive protein (CRP) was (10.9±5.7) mg/dL (range 1.2-30.8 mg/dL), and fibrinogen (FIB) level was (7.0±1.6) g/L (range 3.7-10.8 g/L). All of the laboratory results were statistically higher in the infection group compared with the normal postoperative group (P＜0.001). The synovial white blood cell count (SWBC) of aspirated knee joint fluid was (45.0±29.8)×109/L (range 7.1×109-76.5×109/L). Polymorphonuclear cell percentage (PMNC) was (90.27±7.86) % (range 60%-97%). In the study, 45 patients (69.2%) had positive aspirate cultures. Microbiology showed coagulase-negative Staphylococcus (CNS) and Staphylococcus aureus (SA) were the most common bacterium (34 cases and 7 cases, individually). There were 26 methicillin-resistant Staphylococcus. Both conservative (16 patients) and operative (49 patients) treatments were effective, but conservative group had a longer recovery time (5.6 d vs. 1.6 d, P=0.042). CONCLUSION: Septic arthritis after arthroscopic anterior cruciate ligament reconstruction is a rare but potentially devastating complication. The correct diagnosis relies on synovial fluid analysis and bacterial culture. Our proposed treatment protocol is arthroscopic debridement and antibiotic therapy as quickly as possible.

Identification of the novel HLA-B*13:83 allele by polymerase chain reaction sequence-based typing in a Chinese cord blood donor.

HLA-B*13:83 differs from HLA-B*13:01:01 by 2 nucleotide substitutions at positions 103 and 106.

Identification of the novel null allele, HLA-C*01:109N, using polymerase chain reaction sequence-based typing in a Chinese leukemia patient.

HLA-C*01:109N differs from HLA-C*01:02:01 by a single nucleotide substitution at position 683 G > A.

Identification of the novel HLA-B*39:01:23 allele by polymerase chain reaction sequence-based typing.

HLA-B*39:01:23 differs from HLA-B*39:01:01 by a single nucleotide substitution at position 153 C > T.

A novel allele, HLA-A*33:97 was identified in a Chinese bone marrow donor.

HLA-A*33:97 has one base substitution at position 287 A>T in exon 2 compared to HLA-A*33:03:01.

Identification of the novel HLA-DRB1*12:50 allele by polymerase chain reaction sequence-based typing in a Chinese individual.

HLA-DRB1*12:50 is different from HLA-DRB1*12:02:01 by a single nucleotide substitution at position 320 A>C.

Identification of two novel HLA-A alleles, HLA-A*03:181 and HLA-A*03:229 in Chinese individuals.

HLA-A*03:181 and HLA-A*03:229 differ from HLA-A*03:01:01:01 by one and three nucleotide substitutions, respectively.

Identification of the novel HLA-B*52:42 allele by polymerase chain reaction sequence-based typing in a Chinese bone marrow donor.

HLA-B*52:42 is different from HLA-B*52:01:01:01 by a single nucleotide substitution at position 343G>C.

A novel HLA-B*15 allele, HLA-B*15:326, was identified in a Chinese bone marrow donor.

HLA-B*15:326 has one base substitution at position 176G>A in exon 2 compared with HLA-B*15:01:01:01.

Two novel HLA-A alleles: A*24:258 and A*24:305 were identified in Chinese individuals.

Both HLA-A*24:258 and HLA-A*24:305 differ from HLA-A*24:01:01:01 by single nucleotide substitutions.

A novel allele, HLA-B*55:70 was identified in a Chinese cord blood donor.

HLA-B*55:70 has one base substitution at position 199 C>T in exon 2 compared to HLA-B*55:02:01.

Two novel alleles, HLA-B*46:01:11 and HLA-B*51:01:39 were identified in Chinese bone marrow donors.

HLA-B*46:01:11 has 219 G>A compared with HLA-B*46:01:01, and HLA-B*51:01:39 shows 561 G>A with HLA-B*51:01:01.

Two novel alleles, HLA-A*02:07:06 and HLA-A*02:426, were identified in Chinese individuals.

HLA-A*02:07:06 shows 285 A>C and HLA-A*02:426 has 763 G>A change compared with HLA-A*02:07:01.

Identification of a novel HLA-A*02:06:14 allele by polymerase chain reaction sequence-based typing in a Chinese bone marrow donor.

HLA*02:06:14 differs from HLA-A*02:06:01 by a single nucleotide substitution G > A at position 246.

Genomic full-length sequence of a novel HLA-B*39:01:01:03 allele was identified in a Chinese individual.

HLA-B*39:01:01:03 allele differs from HLA-B*39:01:01:01 allele by a single nucleotide substitution.

Complete microscale profiling of tumor microangiogenesis: a microradiological methodology reveals fundamental aspects of tumor angiogenesis and yields an array of quantitative parameters for its characterization.

Complete profiling would substantially facilitate the fundamental understanding of tumor angiogenesis and of possible anti-angiogenesis cancer treatments. We developed an integrated synchrotron-based methodology with excellent performances: detection of very small vessels by high spatial resolution (~1 µm) and nanoparticle contrast enhancement, in vivo dynamics investigations with high temporal resolution (~1 ms), and three-dimensional quantitative morphology parametrization by computer tracing. The smallest (3-10 µm) microvessels were found to constitute >80% of the tumor vasculature and exhibit many structural anomalies. Practical applications are presented, including vessel microanalysis in xenografted tumors, monitoring the effects of anti-angiogenetic agents and in vivo detection of tumor vascular rheological properties.

Predisposing factors of pituitary hemorrhage.

BACKGROUND AND PURPOSE: The clinical features of pituitary adenomas were retrospectively analyzed, focusing on the factors that contribute to the development of pituitary hemorrhage. Although many causes of pituitary adenoma hemorrhage have been identified, it is difficult to distinguish which conditions are truly causative. We determined the independent variables that contribute to pituitary hemorrhage in pituitary adenoma. METHODS: Two hundred and eighty-eight consecutive patients diagnosed as pituitary adenoma were enrolled. These patients underwent tumor removal through endoscopic transsphenoidal approach. The subjects were divided into hemorrhagic and non-hemorrhagic groups, based on magnetic resonance images and histological findings. The predisposing factors were reviewed in the medical records for all patients. Univariate and multivariate analyses were performed to assess the relationships between variables of pituitary adenoma hemorrhage. RESULTS: We investigated 81 patients in whom hemorrhage from pituitary adenoma occurred. The incidence of pituitary hemorrhage was 28.1% (81/288). The predisposing factors surveyed for pituitary hemorrhage were significantly associated with macroadenoma, non-functional adenomas, anticoagulation therapy, end-stage renal disease, dopamine agonist treatment, and underlying malignant disease (all P < 0.05). Sex, age, hypertension, diabetes mellitus, and previous radiation therapy were not related to pituitary hemorrhage. CONCLUSIONS: In this pooled cohort, the predisposing factors of pituitary adenoma characteristic for pituitary hemorrhage were macroadenoma and non-functional adenoma. Patients who received dopamine agonist and anticoagulation therapy are implicated as precipitating factors. Underlying end-stage renal disease and malignant disease are also factors that contribute to pituitary adenoma hemorrhage.

Fuzzy rules to predict degree of malignancy in brain glioma.

The current pre-operative assessment of the degree of malignancy in brain glioma is based on magnetic resonance imaging (MRI) findings and clinical data. 280 cases were studied, of which 111 were high-grade malignancies and 169 were low-grade, so that regular and interpretable patterns of the relationships between glioma MRI features and the degree of malignancy could be acquired. However, as uncertainties in the data and missing values existed, a fuzzy rule extraction algorithm based on a fuzzy min-max neural network (FMMNN) was used. The performance of a multi-layer perceptron network (MLP) trained with the error back-propagation algorithm (BP), the decision tree algorithm ID3, nearest neighbour and the original fuzzy min-max neural network were also evaluated. The results showed that two fuzzy decision rules on only six features achieved an accuracy of 84.6% (89.9% for low-grade and 76.6% for high-grade cases). Investigations with the proposed algorithm revealed that age, mass effect, oedema, postcontrast enhancement, blood supply, calcification, haemorrhage and the signal intensity of the T1-weighted image were important diagnostic factors.

A spectrophotometric assay of gamma-glutamylcysteine synthetase and glutathione synthetase in crude extracts from tissues and cultured mammalian cells.

An assay of gamma-glutamylcysteine synthetase (gamma-GCS) and glutathione synthetase (GS) in crude extracts of cultured cells and tissues is described. It represents a novel combination of known methods, and is based on the formation of glutathione (GSH) from cysteine, glutamate and glycine in the presence of rat kidney GS for the assay of gamma-GCS, or from gamma-glutamylcysteine and glycine for the assay of GS. GSH is then quantified by the Tietze recycling method. Assay mixtures contain the gamma-glutamyl transpeptidase (GGT) inhibitor acivicin in order to prevent the degradation of gamma-glutamylcysteine and of the accumulating GSH, and dithiothreitol in order to prevent the oxidation of cysteine and gamma-glutamylcysteine. gamma-GCS and GS levels determined by this method are comparable to those determined by others. The method is suitable for the rapid determination of gamma-GCS GS in GGT-containing tissues and for the studies of induction of gamma-GCS and GS in tissue cultures.