The occurrence of asthma in an extensive-stage small-cell lung cancer patient after combination therapy with atezolizumab and anlotinib: a case report.

Background: Extensive-stage small-cell lung cancer (ES-SCLC) is highly malignant, with early metastasis and high recurrence. Since therapeutic options are limited, ES-SCLC has a characteristically short survival period and extremely poor prognosis. A combination of immune checkpoint inhibitors (ICIs) and anti-angiogenic drugs can achieve promising efficacy and safety in patients with ES-SCLC as a second-line or subsequent treatment, extending survival to some extent. However, the clinical outcomes remain mostly unsatisfactory and are sometimes affected by treatment-related adverse events. Case presentation: A 57-year-old woman with ES-SCLC was administered a combination therapy of atezolizumab (a PD-L1 inhibitor) and anlotinib [an oral multi-targeted tyrosine kinase inhibitor (TKI)]. She survived for 22 months, with no disease progression during the 28 courses of therapy. Unexpectedly, despite having no history of asthma, the patient developed asthma while receiving this regimen. This is possibly related to T-cell activation and the tumor immune microenvironment, which induce allergic inflammation after PD-L1 blockade. Conclusions: This is the first report of an asthma-negative ES-SCLC patient who developed asthma after receiving atezolizumab plus anlotinib. Although this combination therapy may effectively extend survival in SCLC patients, asthmatic symptoms should be closely monitored.

Omentin-1 ameliorates pulmonary arterial hypertension by inhibiting endoplasmic reticulum stress through AMPKα signaling.

BACKGROUND: Endothelial dysfunction of the pulmonary artery contributes to hypoxia-induced pulmonary arterial hypertension (PAH). Omentin-1, as a novel adipocytokine, plays an important protective role against cardiovascular diseases. However, the effect and underlying mechanisms of omentin-1 against PAH remain unclear. METHODS: PAH was induced in SD (Sprague & Dawley) rats via a low-oxygen chamber for 4 weeks. Hemodynamic evaluation was undertaken using a PowerLab data acquisition system, and histopathological analysis was stained with hematoxylin and eosin (H&E). Endothelial function of pulmonary artery was assessed using wire myography. RESULTS: We found that omentin-1 significantly improved pulmonary endothelial function in rats exposed to hypoxia and attenuated PAH. Mechanistically, we found that omentin-1 increased phosphorylated 5'­adenosine monophosphate­activated protein kinase (p­AMPK) level and reduced endoplasmic reticulum (ER) stress and increased NO production in pulmonary artery from rats exposed to hypoxia. However, the effect of omentin-1 was abolished by treatment with AMPK inhibitor (Compound C). CONCLUSIONS: Our results reveal a protective effect of omentin-1 in PAH via inhibiting ER stress through AMPKα signaling and provide an agent with translational potential for the treatment of PAH.

Case report: The first account of undifferentiated sarcoma with epithelioid features originating in the pleura.

Undifferentiated epithelioid sarcoma (USEF) is a rare subtype of undifferentiated soft tissue sarcoma that presents unique challenges in clinical diagnosis and treatment. Here, we report a case of USEF occurring in the pleura of a 51-year-old man for the first time. Thoracoscopic examination revealed widespread nodular changes, and pathological analysis confirmed the presence of numerous epithelioid atypical cells. Immunohistochemical (IHC) analysis demonstrated an undifferentiated phenotype with distinct characteristics: epithelial membrane antigen (foci +), vimentin (+), Ki-67 (+70% +), TTF-1 (+), P53 (mutant type +90%), INI-1 (+), and CK5/6 (small foci +). Immunohistochemical examination of the tumor showed that the tumor was an undifferentiated epithelioid sarcoma. High-throughput DNA sequencing revealed pivotal mutations, including a nonsense mutation in the NF1 gene (c.641A > G(p.H214R)). and critical TP53 missense mutation (c.641A > G(p.H214R)). This TP53 mutation, with a tumor mutation burden of 16.5 Muts/Mb, signifies a high level of genomic instability, likely contributing to the rapid progression and aggressiveness of the disease. Detection of the TP53 mutation provides essential insights, indicating the disease's rapid progression and highlighting the potential for targeted therapies. Although the patient's disease progressed extremely rapidly and he tragically died within a week, we discussed the results of IHC and DNA sequencing in detail and discussed his possible treatment options. Insights gained from this case will be critical in shaping future diagnostic and therapeutic paradigms for USEF, particularly in the context of TP53 mutations.

Variety of femoral anteversion and its measurement in cementless total hip arthroplasty: Does robotic technology improve accuracy?

BACKGROUND: High-performance total hip arthroplasty (THA) depends on the accurate position of components. However, femoral anteversion is variable, and current studies only used traditional instruments to evaluate it, such as protractor and spirit level with limited cases. This study aimed to identify the variability in the measured femoral native anteversion and intraoperative stem anteversion under different measurement methods, including intraoperative robotic method. We hypothesized that robotic technology was more accurate than traditional instruments for femoral anteversion evaluation. METHODS: This study included 117 hips of patients who underwent robotic-assisted THA between November 2019 and March 2021. Preoperative native femoral anteversion was measured using a robotic system. Intraoperative femoral stem anteversion was evaluated visually, and then measured with a goniometer and a robotic system, respectively. Variability in the measured femoral native anteversion and intraoperative femoral stem anteversion was calculated and compared. Intraclass correlation coefficient (ICC) and Pearson correlation analysis were used to assess the consistency and correlation of anteversion of different measurements and postoperative CT-measured stem anteversion, respectively. RESULTS: The result of measurement for preoperative native femoral anteversion was more variable than the intraoperative robotic-measured stem anteversion. Intraoperative robotic-measured stem version showed the highest correlation with postoperative CT measurement of stem version (r = 0.806, P < 0.001), while intraoperative surgeon estimation had the lowest correlation coefficient (r = 0.281, P = 0.025). As for the consistency with postoperative CT measurement of femoral stem anteversion, the intraoperative robotic-measured femoral stem version also had the highest value (ICC = 0.892, P < 0.001). CONCLUSION: Native femoral anteversion was variable preoperatively. Using cementless stems, anteversion was also highly variable. Robotic assessment for stem anteversion during surgery was more consistent with the final position than the preoperative assessment and conventional intraoperative estimation.

Using novel porous metal pillars for tibial bone defects in primary total knee arthroplasty.

BACKGROUND: The optimal method to treat tibial bone defects during primary total knee arthroplasty (TKA) is still unclear. A novel technique of porous metal pillar augmentation has been applied recently. This study aimed to assess the short-term outcomes of primary TKA with the use of novel porous metal pillars for tibial bone defects. METHODS: A total of 24 cases (22 patients) of primary TKA between January 2019 and December 2020 using porous metal pillars for tibial bone defects were reviewed. Clinical results were evaluated using the Knee Society knee score (KSKS) and function score (KSFS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and range of motion (ROM). Hip-knee-ankle angle (HKAA), femorotibial angle (FTA), and radiolucent lines were assessed radiologically. RESULTS: The median follow-up period was 36.0 months (interquartile range: 31-37 months). The KSKS, KSFS, WOMAC score, and ROM improved significantly at the final follow-up assessment compared with the preoperative evaluation. Both of the HKAA and FTA were corrected after surgery. Only one knee had a nonprogressive radiolucent line at the bone-cement interface. No radiolucent lines were detected around the pillar in any of the cases. There were no cases of prosthesis loosening and revision. CONCLUSIONS: The use of novel porous metal pillars yielded satisfactory clinical outcomes and reliable radiological evidence of fixation in this study with a minimum 2-year follow-up. Porous metal pillar augmentation can be considered as a valuable and easy-to-use method for the management of tibial bone defects in primary TKA.

Clinical and biomarker analyses of sintilimab plus gemcitabine and cisplatin as first-line treatment for patients with advanced biliary tract cancer.

The prognosis of biliary tract cancer (BTC) remains unsatisfactory. This single-arm, phase II clinical trial (ChiCTR2000036652) investigated the efficacy, safety, and predictive biomarkers of sintilimab plus gemcitabine and cisplatin as the first-line treatment for patients with advanced BTCs. The primary endpoint was overall survival (OS). Secondary endpoints included toxicities, progression-free survival (PFS), and objective response rate (ORR); multi-omics biomarkers were assessed as exploratory objective. Thirty patients were enrolled and received treatment, the median OS and PFS were 15.9 months and 5.1 months, the ORR was 36.7%. The most common grade 3 or 4 treatment-related adverse events were thrombocytopenia (33.3%), with no reported deaths nor unexpected safety events. Predefined biomarker analysis indicated that patients with homologous recombination repair pathway gene alterations or loss-of-function mutations in chromatin remodeling genes presented better tumor response and survival outcomes. Furthermore, transcriptome analysis revealed a markedly longer PFS and tumor response were associated with higher expression of a 3-gene effector T cell signature or an 18-gene inflamed T cell signature. Sintilimab plus gemcitabine and cisplatin meets pre-specified endpoints and displays acceptable safety profile, multiomics potential predictive biomarkers are identified and warrant further verification.

Successful treatment with osimertinib for nonmucinous bronchioloalveolar carcinoma with massive bronchorrhea and respiratory failure: a case report and literature review.

Background: Correct diagnosis of bronchioloalveolar carcinoma (BAC) is often delayed due to the lack of familiarity with the condition among clinicians as its sporadic nature and its symptoms are similar to other respiratory issues. Among these, acute respiratory failure (ARF) caused by massive bronchorrhea is rarely associated with BAC. Here we first reported osimertinib in the treatment of BAC with bronchorrhea and ARF. Case Description: A 38-year-old woman presented with massive bronchorrhea and progressive dyspnea. A chest computed tomography (CT) scan showed consolidation with air bronchograms and multiple nodules in both lungs. The patient had no history of chronic pulmonary disease, diabetes mellitus, hypertension or smoke. The patient was initially diagnosed with pneumonia, but ARF developed despite the antibiotic therapy provided. Lung biopsy results revealed nonmucinous BAC. Osimertinib (80 mg daily) was prescribed and proved effective for the first time with an improved ARF and a decreased multiple nodules or consolidation in the lungs during the follow-up period. Conclusions: It is important for physicians to recognize the typical symptoms and radiological manifestations of BAC to avoid misdiagnosis or late diagnosis. This is especially important since early diagnosis allows for immediate epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) therapy, which is a potentially beneficial treatment for patients with BAC.

Medial wall reconstruction using metal disc augments in revision total hip arthroplasty.

PURPOSE: Medial acetabular bone defects are frequently encountered in revision total hip arthroplasty (THA), but few studies have focused on their reconstruction. This study aimed to report the radiographic and clinical results after medial acetabular wall reconstruction using metal disc augments in revision THA. METHODS: Forty consecutive revision THA cases using metal disc augments for medial acetabular wall reconstruction were identified. Post-operative cup orientation, the centre of rotation (COR), stability of acetabular components and peri-augments osseointegration were measured. The pre-operative and post-operative Harris Hip Score (HHS) and Western Ontario and McMaster Universities Arthritis Index (WOMAC) were compared. RESULTS: The mean post-operative inclination and anteversion were 41.88 ± 6.70° and 16.73 ± 5.35°, respectively. The median vertical and lateral distance between the reconstructed CORs and the anatomic CORs were -3.45 mm (interquartile range [IQR]: -11.30 mm, -0.02 mm) and 3.18 mm (IQR: -0.03 mm, 6.99 mm). Thirty-eight cases completed the minimum two year clinical follow-up, whereas 31 had a minimum two year radiographic follow-up. Acetabular components were radiographically stable with bone ingrowth in 30 cases (30/31, 96.8%) while one case was classified as radiographic failure. Osseointegration around disc augments was observed in 25 of 31 cases (80.6%). The median HHS improved from 33.50 (IQR: 27.50-40.25) pre-operatively to 90.00 (IQR: 86.50-96.25) (p < 0.001), whereas the median WOMAC significantly improved from 38.02 (IQR: 29.17-46.09) to 85.94 (IQR: 79.43-93.75) (p < 0.001). CONCLUSION: In revision THA with severe medial acetabular bone defect, disc augments could provide favorable cup position and stability, peri-augments osseointegration, with satisfactory clinical scores.

[Short-term effectiveness of medial unicompartmental knee arthroplasty in patients younger than 60 years of age].

Objective: To compare the short-term effectiveness of medial unicompartmental knee arthroplasty (UKA) between patients younger or older than 60 years of age, and to investigate the impact of age on the effectiveness. Methods: The clinical data of 182 patients (182 knees) who underwent medial UKA between July 2016 and June 2018 were retrospectively analyzed, of which 72 patients were less than 60 years old (group A) and 110 patients were more than 60 years old (group B). There was a significant difference in age between groups (t=-20.198, P<0.001). No significant difference was found in gender, body mass index, surgical sides, Kellgren-Lawrence grading, disease duration, and preoperative Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score between groups (P>0.05). The postoperative hospital stay and complications were recorded, and the WOMAC score, satisfaction score, and prosthesis revision were compared between groups. Results: The length of postoperative hospital stay was (4.50±1.09) days in group A, and (4.46±1.29) days in group B, with no significant difference between groups (t=0.198, P=0.844). All incisions healed by first intention. The incidences of early postoperative complications in groups A and B were 5.6% and 3.6%, respectively, and the difference was not significant (χ2=0.061, P=0.804). All patients were followed up. The follow-up time were 28-50 months (mean, 36 months) in group A and 28-50 months (mean, 35 months) in group B. At last follow-up, the WOMAC scores of both groups significantly improved when compared with those before operation (P<0.05), and there was no significant difference between groups (P>0.05) in the difference before and after operation. The satisfaction scores were 6.6±1.7 in group A and 6.9±1.6 in group B, with no significant difference between groups (t=-1.326, P=0.186). There was no revision surgery in both groups during follow-up period. Conclusion: Age has no significant effect on the prognosis of medial UKA, and patients younger than 60 years of age can also obtain good short-term effectiveness.

Symptom duration is associated with failure of periprosthetic joint infection treated with debridement, antibiotics and implant retention.

Background: Debridement, antibiotics, and implant retention (DAIR) is an alternative treatment strategy for periprosthetic joint infection (PJI). However, no consensus exists regarding which patient population(s) may be most suitable for DAIR. This study aims to investigate the overall infection control rate and explore the prognostic factors associated with acute, hematogenous, and chronic PJIs treated with DAIR. Methods: We retrospectively reviewed the included patients who were diagnosed with PJI and underwent DAIR at two institutions from 2009 to 2018 (n = 104). We collected the clinical data, including demographics, preoperative laboratory tests, Charlson Comorbidity Index, surgical information, and culture organism results. Treatment success was defined according to the criteria reported by Diaz-Ledezma. All patients were followed for at least one year unless failure preceded that time point. A multivariable analysis was utilized to identify prognostic factors associated with treatment, and a Kaplan-Meier survival analysis was used to depict the infection control rate. Results: The overall treatment success rate in the current cohort of patients was 67.3% at a median 38.6 (interquartile range: 23.5, 90.7) months follow-up. Patients with a duration of infectious symptoms of more than ten days were more likely to fail (P = 0.035, hazard ratio 8.492, 95% confidence interval 1.159-62.212). There was no difference among acute, hematogenous, and chronic infections in terms of failure rate (P = 0.161). Conclusions: DAIR is a reasonable treatment option for PJI, and its use in the setting of chronic infection does not appear to be a contraindication. Performing DAIR within ten days of the presentation of symptoms had a higher rate of treatment success.

New insights into the genus Gyroporus (Gyroporaceae, Boletales), with establishment of four new sections and description of five new species from China.

Species of Gyroporus from southern China were studied in this study. Based on morphology and molecular phylogenetic analyses of DNA sequences from the nuclear ribosomal internal transcribed spacer (ITS), the nuclear ribosomal large subunit (nrLSU), and the mitochondrial adenosine triphosphate ATP synthase subunit 6 (atp6), Gyroporus was divided into four main branches in the phylogenetic tree, and four sections were firstly proposed i.e. Gyroporus sect. Castaneus, G. sect. Cyanescens, G. sect. Longicystidiatus and G. sect. Pallidus. Five new species, i.e. G. alboluteus, G. atrocyanescens, G. pseudolongicystidiatus, G. pallidus and G. subcaerulescens, were revealed from China, and their phylogenetic positions were also analysed. Among them, G. alboluteus and G. pallidus were nested into the sect. Pallidus, although morphologically similar to G. castaneus; G. atrocyanescens and G. subcaerulescens, with obvious cyanescent oxidation reactions, were nested into the sect. Cyanescens; and G. pseudolongicystidiatus characterised by its long cystidia and was nested into the sect. Longicystidiatus. The new species were formally described and illustrated in the present study, and a key to the sections and species of Gyroporus in China was provided.

NOTCH1 mutation associates with impaired immune response and decreased relapse-free survival in patients with resected T1-2N0 laryngeal cancer.

Background: Patients with early-stage laryngeal cancer, even stage T1-2N0, are at considerable risk of recurrence and death. The genetic and immunologic characteristics of recurrent laryngeal cancer remain unclear. Methods: A total of 52 T1-2N0 laryngeal cancer patients were enrolled. Of these, 42 tissue samples were performed by targeted DNA sequencing, and 21 cases were performed by NanoString immuno-oncology targeted RNA sequencing to identify the distinct molecular bases and immunologic features associated with relapse in patients with early laryngeal cancer, respectively. Results: To the best to our knowledge, we present for the first time an overview of the genomic mutation spectrum of early-stage laryngeal cancers. A total of 469 genomic alterations were detected in 211 distinct cancer-relevant genes, and the genes found to be mutated in more than five patients (>10%) included tumor protein p53 (TP53, 78.5%), FAT atypical cadherin 1 (FAT1, 26%), LDL receptor related protein 1B (LRP1B, 19%), cyclin dependent kinase inhibitor 2A (CDKN2A, 17%), tet methylcytosine dioxygenase 2 (TET2, 17%), notch receptor 1 (NOTCH1, 12%) and neuregulin 1 (NRG1, 12%). Recurrent laryngeal cancer demonstrated a higher tumor mutation burden (TMB), as well as higher LRP1B mutation and NOTCH1 mutation rates. Univariate and multivariate analyses revealed that high TMB (TMB-H) and NOTCH1 mutation are independent genetic factors that are significantly associated with shorter relapse-free survival (RFS). Simultaneously, the results of the transcriptome analysis presented recurrent tumors with NOTCH1 mutation displayed upregulation of the cell cycle pathway, along with decreased B cells score, T cells score, immune signature score and tumor-infiltrating lymphocytes (TILs) score. The Cancer Genome Atlas (TCGA)-laryngeal cancer dataset also revealed weakened immune response and impaired adhesion functions in NOTCH1-mutant patients. Conclusions: Genomic instability and impaired immune response are key features of the immunosurveillance escape and recurrence of early laryngeal cancer after surgery. These findings revealed immunophenotypic attenuation in recurrent tumors and provided valuable information for improving the management of these high-risk patients. Due to the small number of patients in this study, these differences need to be further validated in a larger cohort.

Predictors of a forgotten joint after medial fixed-bearing unicompartmental knee arthroplasty.

BACKGROUND: A forgotten joint is considered the ultimate goal of joint replacement. We aim to explore the predictive factors of a forgotten joint after fixed-bearing unicompartmental knee arthroplasty (UKA). METHODS: This retrospective cohort study used prospectively collected data from 302 cases of medial-compartment UKA with a minimum of 2-year follow-up. The primary outcome was the achievement of a forgotten joint after UKA, according to the Forgotten Joint Score (FJS-12) at the last follow-up. Patients with FJS-12 > 84 were considered to have forgotten UKA. Univariate and multivariate logistic regression analyses were conducted with preoperative patient characteristics and surgery-related factors as potential predictors. RESULTS: Of patients, 94 (31.1%) achieved a forgotten joint post-surgery. Multivariate logistic regression analysis revealed that preoperative hip-knee-ankle angle (HKAA), anatomic lateral distal femoral angle (aLDFA), and postoperative HKAA and HKAA changes were independent predictors of a forgotten joint. The probability of achieving a forgotten joint increased by 29% (OR = 1.29, 95% CI: 1.12-1.51) with a 1° increase in aLDFA. Preoperative HKAA, postoperative HKAA, HKAA changes (ΔHKAA), and outcomes exhibited a non-linear relationship. The probability of achieving a forgotten joint was the highest with preoperative HKAA > 172.0°, postoperative HKAA of 176.0-178.5°, and ΔHKAA < 5.5°. CONCLUSION: To achieve the forgotten joint state, the ideal HKAA range after medial fixed-bearing UKA is 176.0-178.5° and ΔHKAA should be <5.5°. Patients with smaller preoperative aLDFA and HKAA have a lower probability of achieving a forgotten joint after UKA.

Antineutrophil cytoplasmic antibody-associated vasculitis with alveolar hemorrhage and ruptured renal aneurysm: A case report and literature review.

RATIONALE: Antineutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis (AAV) is characterized by necrotizing damage to small-vessel vasculitis and mainly occurs in the kidney or lung. We report a rare case of AAV manifesting as alveolar hemorrhage and a renal aneurysm. PATIENT CONCERNS: A 50-year-old Chinese man presented with repeated coughing, expectoration, fever, hypoxemia, and respiratory failure. The patient suffered from rupture of the renal aneurysm during immunosuppressive therapy. DIAGNOSIS: Considering the clinical picture (fever, progressive hypoxemia, renal insufficiency, hemorrhagic bronchoalveolar lavage fluid, and left retroperitoneal hematoma) along with cANCA-PR3 positivity, and lung biopsy findings, the patient was finally diagnosed with granulomatosis with polyangiitis complicated by alveolar hemorrhage and renal aneurysm. INTERVENTIONS: The patient was initially treated with immunosuppressive therapy combined with plasma exchange and subsequently with renal arterial embolization due to rupture of the renal aneurysm. OUTCOMES: The general condition and inflammatory reaction improved with immunosuppressive therapy combined with plasma exchange. Unfortunately, the patient did not respond to treatment and eventually died of respiratory failure and acute kidney injury after the rupture of the renal aneurysm. LESSONS: We encountered unprecedented difficulties and challenges with renal aneurysm rupture. The possibility of aneurysmal rupture should be carefully considered and frequently checked for immunosuppressive therapy for AAV.

Different Deformity Origins and Morphological Features in Subtypes of Valgus Knees: A Radiological Classification System.

OBJECTIVE: To analyze the deformity origins and distribution among valgus knees to individualize their morphological features. METHODS: Radiographic images of 105 valgus knees were analyzed. Long-film radiographs and computed tomography were collected for every knee. A malalignment test was performed on standing long-film radiographs. The hip-knee-ankle angle (HKA), the anatomical lateral distal femoral angle (aLDFA), and the anatomical medial proximal tibial angle (aMPTA) were measured on long-film radiographs. The distal condylar angle and posterior condylar angle on distal femur were further measured on computed tomography scans. The tibial bone varus angle was measured on long-film radiographs as well. All the valgus knees were sorted into different subtypes according to the origins of bony deformity, and the prevalence of each subtype was reported. Finally, to examine the inter-observer reproducibility of this classification system, two observers measured the deformities and did the classification for all the 105 knees independently and then the intraclass correlation coefficient (ICC) was calculated. RESULTS: Among the 105 knees, 48 knees (45.7%) had apparent deformity from the tibial plateau, and 62 knees (59.0%) had apparent deformity from the supracondylar region of the femur. Eighteen knees (17.1%) had distal condylar angle >7°, among which 11 knees had posterior condylar angle >3° simultaneously. Valgus knees had five subtypes of bone deformity origins-the supracondylar part of the femur, the distal aspect of the lateral femoral condyle, both distal and posterior aspects of the lateral femoral condyle, the tibial plateau, or the metaphyseal segment of the tibia. A valgus knee could be labeled as only one subtype, or a combination of two or more subtypes. Labeling 105 knees with origin of the most severe deformity, the prevalence of each subtype was 40.0%, 5.7%, 9.5%, 28.6%, and 16.2%, respectively. The intra-observer and inter-observer ICC of this classification system was 0.992 and 0.976, respectively. CONCLUSIONS: Valgus knees can be classified into different subtypes according to deformity origins. This radiological classification system has satisfactory reproducibility. It helps surgeons better individualize morphological features of valgus knees.

Reliability and validity of commonly used patient-reported outcome measures (PROMs) after medial unicompartmental knee arthroplasty.

INTRODUCTION: Many patient-reported outcome measures (PROMs) have been utilized to assess outcomes after unicompartmental knee arthroplasty (UKA). However, most are not specifically designed for UKA and the measurement properties of these PROMs have never been elucidated in the setting of UKA. This study aimed to evaluate the reliability and validity of commonly used PROMs after UKA, which includes the Oxford knee score (OKS), Knee Society Score (KSS)-function score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Knee Injury and Osteoarthritis Outcome Score (KOOS). HYPOTHESIS: The four commonly used PROMs after UKA are of good reliability and validity, but with different floor/ceiling effect. MATERIAL AND METHODS: Prospectively collected postoperative follow-up PROMs scores of patients after medial UKA cases for osteoarthritis between May 2015 and June 2018 were retrospectively analyzed. All of the PROMs were finished on the same electronic questionnaires. Reliability (internal consistency, test-retest reliability, measurement error), construct validity and floor/ceiling effects were assessed. RESULTS: The whole cohort was composed of 207 cases, with a median age of 62.0 years and a male ratio of 59/207 (28.50%). Internal consistency was high in the OKS, weak in the KSS-function score and with redundancy in the WOMAC and KOOS scores (Cronbach alpha=0.915, 0.610, 0.953, 0.961, respectively). Each of the four PROMs had a high test-retest reliability (all intraclass correlation coefficient (ICC) >0.97). Convergent validity of the four PROMs with the physical component score of the 12-Item Short Form Health Survey (SF-12 PCS) were proven (all r>0.5; p<0.001). While no ceiling effect occurred in the OKS, one was detected in the KSS-function score with 19.81% of patients achieving the best possible score, as well as in the WOMAC sub-score for pain (54.11%) and stiffness (50.72%), in addition to the KOOS sub-score for symptoms (27.54%) and pain (38.16%). DISCUSSION: The four commonly used PROMs after UKA showed good test-retest reliability and construct validity. The OKS is more recommended for its better performance in internal consistency and ceiling effect than the KSS-function score, the WOMAC and KOOS scores. LEVEL OF EVIDENCE: III; Diagnostic study.

Better PROMs and higher return-to-sport rate after modular bicompartmental knee arthroplasty than after total knee arthroplasty for medial and patellofemoral compartment osteoarthritis.

Background: Theoretical advantages of bicompartmental knee arthroplasty (BKA) over total knee arthroplasty (TKA) for bicompartmental (medial combined with patellofemoral) osteoarthritis (OA) are still unclear. This study aimed to compare patient-reported outcome measures (PROMs) and return-to-sport (RTS) rate between modular BKA and TKA in early follow-up. Methods: Twenty-five consecutive modular BKA cases with a minimum 2-year follow-up were matched with 50 TKA cases at 1:2 ratio. Demographic data and preoperative functional scores, including the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Knee Society Scores (KSSs), were analyzed to ensure comparability. Postoperative WOMAC score, KSS, range of motion (ROM), Forgotten Joint Score-12 (FJS-12), and RTS rates were compared. Operative time and blood loss were also analyzed. Results: Significant differences in the WOMAC-function (median 97.1 vs. 89.7, p < 0.001) and KSS-function (median 90.0 vs. 80.0, p = 0.003) scores were identified between the BKA and TKA groups. ROM was significantly greater in the BKA group than in the TKA group (median 125.0° vs. 120.0°, p = 0.004), in addition to the FJS-12 (median 89.6 vs. 53.1, p < 0.001). The overall RTS rate was significantly higher in the BKA group than in the TKA group (71.6% vs. 56.5%, p = 0.039). Operative time was significantly longer in the BKA group than in the TKA group (median 105.0 vs. 67.5 min, p < 0.001), but blood loss was similar (median 557.6 vs. 450.7 ml, p = 0.334). Conclusion: Modular BKA demonstrated better functional recovery, better joint perception, and higher RTS rate than TKA; thus, modular BKA can be a good alternative for bicompartmental OA.

[Short-term effectiveness of novel computer navigation system assisted total knee arthroplasty].

OBJECTIVE: To investigate the short-term effectiveness of novel computer navigation system (Knee 3 software; Brainlab, Germany) assisted total knee arthroplasty (TKA). METHODS: Between July 2020 and December 2020, 19 patients underwent unilateral TKA assisted with Knee 3 software. There were 4 males and 15 females. The mean age was 66.3 years (range, 52-79 years). Eighteen patients were diagnosed with osteoarthritis and 1 patient with rheumatoid arthritis. Sixteen patients had varus knees and 3 patients had valgus knees. Preoperative Western Ontario and McMaster University Osteoarthritis Index (WOMAC) pain, stiffness, function, and total scores were 12.4±3.4, 2 (1, 4), 22 (18, 29), and 37 (29, 43), respectively. Intraoperatively, the medial and lateral gaps in knee extension and in 90° of knee flexion were recorded. The operation time, intraoperative blood loss, blood transfusion, and complications were recorded. The hip-knee-ankle angle (HKA), lateral distal femoral angle, and medial proximal tibial angle were measured to evaluate lower limb alignment and prostheses's alignment using X-ray films at 6 weeks after operation. Patient's satisfaction rate and WOMAC pain, stiffness, function, and total scores were investigated. RESULTS: Eighteen patients (94.7%) had medial- lateral gap balancing in knee extension, 18 patients (94.7%) had medial-lateral gap balancing in 90° of knee flexion, 19 patients (100%) had medial gap balancing between knee extension and 90° of knee flexion, and 18 patients (94.7%) had lateral gap balancing between knee extension and 90° of knee flexion. The mean operation time was 126 minutes (range, 100-200 minutes). The mean intraoperative blood loss was 205 mL (range, 100-400 mL). Patients were followed up 4-8 months, with an average of 6.2 months. Postoperative complications included 1 deep vein thrombosis of lower extremities and 1 cerebral infarction. X-ray films showed that the mean HKA, lateral distal femoral angle, and medial proximal tibial angle were 179.8° (range, 178°-182°), 83.5° (range, 80°-87°), and 89.5° (range, 87°-93°), respectively. At last follow-up, WOMAC pain, stiffness, function, and total scores were 3.6±1.9, 0 (0, 2), 4 (2, 6), and 9 (5, 10), respectively, which improved when compared with preoperative scores ( P<0.05). Twelve patients were very satisfied with the operation results and 7 patients were satisfied with the operation results. The overall satisfaction rate was 100%. CONCLUSION: Knee 3 software can help to obtain good gap balancing and optimal lower limb alignment, with high patient's satisfaction and good short-term effecectiveness.

Visualization of the renal vein filled with contrast agent may indicate the renal vein injury during percutaneous nephrolithotomy: two case reports.

BACKGROUND: Intravenous misplacement of a nephrostomy tube is a rare complication of percutaneous nephrolithotomy (PCNL) or percutaneous nephrostomy. The mechanism of misplacement of a nephrostomy tube into the vascular system is seldom investigated. One type of the possible mechanism is that the puncture needle penetrates a major intrarenal tributary of the renal vein and enters the collecting system. However, the guidewire is located outside the collecting system near the large branches of renal vein or perforates into the renal vein. The dilation is performed and causes a large torn injury. Subsequently, the nephrostomy tube is placed inside the vessel when radiological monitoring is not used. However, there is no imaging evidence and the scene of procedure is not demonstrated. This paper reports two cases of visualization of the renal vein filled with contrast agent during PCNL. The findings may be good evidence to support the step of renal vein injury in patients with intravenous nephrostomy tube misplacement. CASE PRESENTATION: We presented two cases with visualization of the renal vein filled with contrast agent during PCNL. In the process of injecting the contrast agent through the puncture needle, we could see the renal vein. Moreover, it was identified that the puncture needle tip was not on the optimal position. The position of puncture needle tip lay outside the collecting system, which was close to the calyceal infundibulum and branches of renal vein. CONCLUSIONS: Visualization of the renal vein filled with contrast agent may be good evidence to verify the renal vein injury in patients with intravenous nephrostomy tube misplacement during PCNL or percutaneous nephrostomy. The suboptimal location of the puncture needle tip and visualization of the renal vein filled with contrast agent indicate the renal vein injury. One type of mechanism of intravenous nephrostomy tube misplacement is as following. Firstly, the guidewire stays outside the collecting system. Subsequently, dilatation directed by the guidewire results in the injury of the vein. Then, the nephrostomy tube migrates into the venous system due to prompt tube inserting and the direction of the sheath and/or the guidewire to the injured vein.

Alcohol inhibits alveolar fluid clearance through the epithelial sodium channel via the A2 adenosine receptor in acute lung injury.

Chronic alcohol abuse increases the risk of mortality and poor outcomes in patients with acute respiratory distress syndrome. However, the underlying mechanisms remain to be elucidated. The present study aimed to investigate the effects of chronic alcohol consumption on lung injury and clarify the signaling pathways involved in the inhibition of alveolar fluid clearance (AFC). In order to produce rodent models with chronic alcohol consumption, wild­type C57BL/6 mice were treated with alcohol. A2a adenosine receptor (AR) small interfering (si)RNA or A2bAR siRNA were transfected into the lung tissue of mice and primary rat alveolar type II (ATII) cells. The rate of AFC in lung tissue was measured during exposure to lipopolysaccharide (LPS). Epithelial sodium channel (ENaC) expression was determined to investigate the mechanisms underlying alcohol­induced regulation of AFC. In the present study, exposure to alcohol reduced AFC, exacerbated pulmonary edema and worsened LPS­induced lung injury. Alcohol caused a decrease in cyclic adenosine monophosphate (cAMP) levels and inhibited α­ENaC, ß­ENaC and γ­ENaC expression levels in the lung tissue of mice and ATII cells. Furthermore, alcohol decreased α­ENaC, ß­ENaC and γ­ENaC expression levels via the A2aAR or A2bAR­cAMP signaling pathways in vitro. In conclusion, the results of the present study demonstrated that chronic alcohol consumption worsened lung injury by aggravating pulmonary edema and impairing AFC. An alcohol­induced decrease of α­ENaC, ß­ENaC and γ­ENaC expression levels by the A2AR­mediated cAMP pathway may be responsible for the exacerbated effects of chronic alcohol consumption in lung injury.