[One-stage revision for reconstructing acetabular defects by trabecular metal acetabular revision system in periprosthetic joint infection].

Objective: To investigates the clinical efficacy of the trabecular metal acetabular revision system (TMARS) in one-stage reconstruction of acetabular deficiencies associated with periprosthetic joint infection (PJI). Methods: This is a retrospective case series study,including the data of 59 patients with PJI underwent acetabular defect reconstruction by TMARS during one-stage revisions in the Department of Orthopaedics, the First Affiliated Hospital of Xinjiang Medical University from January 2013 to December 2021. There were 32 males and 27 females, aged (59.5±14.6) years (range: 26 to 84 years). Among them, 29 cases used tantalum cups, 13 cases used tantalum cups and tantalum reinforcing blocks, 9 cases used cup-cage, and 8 cases used multi-cup reconstruction techniques. The surgery procedure, Harris Hip score (HHS), recovery of the hip rotation center, implant survival rate, postoperative reinfection rate, and complications were recorded. Data were compared using the Wilcoxon rank-sum test. Results: All of the 59 patients underwent the operations successfully. Operation time was (188.9±48.4) minutes (range: 110 to 340 minutes), and intraoperative bleeding volume was (M(IQR)) 1 000(400)ml (range: 600 to 1 800 ml). After a postoperative follow-up of 5.1 (2.6) years (range: 2.0 to 10.5 years), the prosthesis survival rate was 94.9% (56/59). Recurrence of infection occurred in 3 cases (5.1%), aseptic loosening in 1case(1.7%), and hip dislocation in 4 cases (6.8%). At the last follow-up, HHS improved significantly(84 (12) vs. 44 (9), Z=-6.671, P<0.01), and the center of rotation of the hips were recovered in all cases. Conclusions: In one-stage revision surgeries aimed at reconstructing acetabular defects, utilizing the TMARS can provide stable initial fixation, restore a more natural center of rotation, significantly enhance early postoperative hip joint function, and reduce the likelihood of infection recurrence. This approach stands as a reliable choice for addressing acetabular defects during revision surgeries for infected hip joints.

[Efficacy evaluation of one-stage revision combined with intra-articular injection of antifungal agents in the treatment of chronic periprosthetic fungal infection].

Objective: To investigate the clinical effect of one-stage revision combined with intra-articular injection of antifungal agents in the treatment of chronic periprosthetic fungal infection. Methods: A retrospective analysis of 11 patients(4 hips, 7 knees) admitted with chronic periprosthetic fungal infection at Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University from January 2004 to April 2016.There were males and females with an age of 67 years (range:47-77 years). Each patient underwent single-stage revision including aggressive soft-tissue debridement. Liquid samples and tissue samples were immediately sent to the microbiology laboratory for drug sensitivity testing and histological analysis. Removed the infected components and cement thoroughly, pouring powdered vancomycin into the medullary cavity and direct intra-articular injection of fungussensitive antibiotics. The patients with infected hips received an uncemented prosthesis and 0.5 g of gentamicin loaded commercial cement was received by the patients with infected knee.After that, a new prosthesis was implanted.Long-term combination therapy of antibacterial agents and antifungal agents were given after operation. Recurrence of infection and clinical outcomes were evaluated. The follow-up period was 5 years (range: 2-12 years). Results: One patient died of acute heart failure on the eighth postoperative day.Three infection cases were recurred.Eight cases had satisfactory outcomes and required no additional surgical or medical treatment for recurrence of infection. The Harris hip score assessed preoperatively and at latest follow-up was increased from 39.25±5.12 to 79.50±4.79, the difference was statistically significant (t=-11.356, P=0.001).The Hospital for Special Surgery knee score was improved from preoperative 46.25±5.61 to final follow-up 80.50±5.06, and the difference was statistically significant (t=-9.930, P=0.002). Conclusion: Treatment of chronic fungal periprosthetic joint infection with single-stage revision can be fairly effective for achieving acceptable functional outcomes.

[Investigation on sleep quality of nurses in emergency departments of tertiary hospitals and analysis of influencing factors].

Objective: To understand the status quo of sleep quality of nurses in emergency department and explore its influencing factors, so as to provide reference for relevant departments to formulate corresponding policies and ensure the health of nurses. Methods: From July to September 2018, 257 nurses in emergency department of 5 tertiary hospitals in a city were investigated by cluster sampling. Results: The detection rate of sleep among 257 nurses was 63.42%. Logistic regression model showed that having children or not (OR=1.063) , self-rated health (OR=1.639) , stress (OR=1.728) and coping style (OR=1.055) were independent influencing factors of sleep quality of nurses in emergency department. Conclusion: Sleep problems are common among nurses in emergency department. It is helpful to improve sleep quality to ensure physical and mental health, actively cope with work and family stress.

[Effect of total hip arthroplasty in patients with stiff hip and severe length discrepancy].

Objective: To observe the outcomes of total hip arthroplasty in patients with stiff hip and moderate or severe leg length discrepancy and to explore the strategy for balance recovery. Methods: A retrospective review was conducted on the clinical data of 30 patients who had stiff hip and moderate or severe leg length discrepancy treated with unilateral primary total hip arthroplasty at Department of Joint Surgery, First Affiliated Hospital of Xinjiang Medical University from January 2014 to January 2017.There were 18 male and 12 female patients aging of (43.5±9.7)years (range, 30-68 years). All patients had different degrees of pelvic tilt and scoliosis. In operation, contractured soft tissues were released, periarticular osteophytes were removed thoroughly and the center of ratation was restablished without femoral shortening osteotomy.Patient satisfaction, Harris hip score, perceived leg length discrepancy (LLD), true LLD and functional LLD were collected.Data were analyzed by paired-samples t-test. Results: The mean follow-up duration was (17.6±7.6)months (range, 12-30 months). The Harris hip score was improved from 37.6±5.7 preoperatively to 84.3±5.2 at last follow-up (t=-57.54, P=0.000). The preoperative and last follow-up data of true LLD((3.19±0.82)cm vs.(0.70±0.71)cm), functional LLD((4.36±1.72)cm vs.(0.46±0.53)cm) and perceived LLD((7.74±2.01)cm vs.(0.98±0.79)cm) was significantly difference(t=26.47, t=15.05, t=26.9, P<0.01). Twenty-seven patients were restored to normal level (LLD≤10 mm ) and there was no sciatic nerve injury observed after surgery. 90.0% (27/30) patients were satisfied by the outcome. Conclusions: Total hip arthroplasty have satisfactory effect in correcting leg-length discrepancy of stiff hip patients. Preoperative assessment, individualized surgical methods and soft tissue releasing are important for balance recovery of affected limbs.

[Influence of patellofemoral joint degeneration on outcome of medial unicompartmental knee arthroplasty].

Objective: To evaluate the influence of patellofemoral joint degeneration and pre-operative pain location on the outcome of medial Oxford unicompartmental knee arthroplasty (UKA). Methods: A total of 58 patients (58 knees) with medial Oxford UKA had been performed for medial osteoarthritis from March 2013 to July 2014 in Department of Orthopaedic Surgery at First Teaching Hospital of Xinjiang Medical University were retrospective reviewed. There were 24 males and 34 females, the age from 43 to 87 years with the mean age was 68.5 years. The mean body mass index was 25.2 kg/m(2) ranging from 19.7 to 31.5 kg/m(2). Patients were divided into anterior-medial pain group (35 knees), anterior knee pain group (17 knees) and general knee pain group (6 knees) according to pre-operative pain location. Pre-operative radiological statuses of the patellefemoral joint were defined by Ahlback system and divided into patellofemoral joint degeneration group (16 knees) and normal group (42 knees). Patients were also divided into medial patellofemoral degeneration group (20 knees), lateral patellofemoral degeneration group (12 knees) and normal group (26 knees) according to Altman scoring system. Outerbridge system was used intraoperatively and the patients were divided into patellofemoral joint degeneration group (21 knees) and normal group (37 knees). Pre- and post-operative outcomes were evaluated with Oxford Knee Score (OKS), Western Ontario and MacMaster (WOMAC) and patellofemoral score system of Lonner. T test and ANOVA were used to analyze the data. Results: The average duration of follow-up was 33 months (from 26 to 42 months). There were no patients had complications of infection, deep vein thrombosis, dislocation or loosing at the last follow-up. Compared to pre-operation, OKS (18.9±3.5 vs. 38.9±4.7, 19.3±4.2 vs. 39.6±4.6, 18.1±3.2 vs. 38.1±3.7)(t=5.64 to 7.08, all P<0.01) and WOMAC (10.9±2.3 vs.53.2±4.5, 10.4±2.1 vs.54.6±3.4, 11.7±1.8 vs.52.8±3.7)(t=14.50 to 19.16, all P<0.01) decreased, and the Lonner score (88.9±3.4 vs.38.6±2.8, 87.5±4.1 vs.38.2±2.3, 88.2±3.2 vs. 37.6±3.5)(t=-19.78 to -18.16, all P<0.01) increased significantly in anterior-medial pain group, anterior knee pain group and general knee pain group. According to Ahlback scoring system, compared to pre-operation, OKS (18.3±2.4 vs. 38.7±4.4, 19.6±1.8 vs. 38.4±3.1)(t=7.05, 9.08, both P<0.01) and WOMAC (10.6 ±2.6 vs.53.2±4.5, 12.1±1.4 vs.52.4±3.3)(t=14.21, 19.52, both P<0.01) decreased, the Lonner score (88.1±3.1 vs.38.3±3.3, 86.9±2.6 vs.39.1±2.4)(t=-18.90, -23.40, both P<0.01) increased significantly in patellofemoral joint degeneration group and normal group, the outcomes were the same according to Altman and Outerbridge scoring system. There was no significant difference between patellofemoral joint degeneration group and normal group based on Ahlback grading system. According to Altman classification, compared to normal group, there was no statistically differences in OKS, WOMAC and Lonner scoring system between patients with degeneration in the medial patellofemoral joint group, OKS and WOMAC increased (20.2±1.4 vs.18.2±2.7, 12.5±1.7 vs.10.5±2.5) (t=-4.30, P=0.03; t=-4.80, P=0.02), the Lonner score decreased (84.3±2.8 vs.87.4±3.2) (t=-6.20, P=0.01) in lateral patellofemoral degeneration group. According to Outerbridge scoring system, there were no statistically differences in patients in patellofemoral joint degeneration group and normal group. Conclusions: There is a good evidence that neither mild to moderate degree of patellofemoral joint degeneration nor pre-operative pain location will compromise the short-term outcome of medial Oxford UKA, and should not be considered as contraindications. The situation is less clear for lateral patellofemoral degeneration, and more cautious option is advised.

[The correlation study between the changes of intestinal mucosa predominant bacteria and Toll-like receptor 2, Toll-like receptor 4 gene expressions in diarrhea-predominant irritable bowel syndrome patients].

Based on high throughput sequencing and PCR detection technology, this study has found out that intestinal microbial diversity was impaired and the quantities of two main bacteria flora (Bacteroidetes and Clostridium) were significantly reduced in patients with diarrhea-predominant irritable bowel syndrome (D-IBS). Meanwhile mucosal expression of toll-like receptor (TLR) 2 and TLR4 were significantly enhanced, which was inversely correlated with the reduction of Bacteroidetes and Clostridium. Thus, it suggests that D-IBS may be associated with TLR signal transduction triggered by the intestinal dysbacteriosis.

Suppression of epithelial-mesenchymal transition and apoptotic pathways by miR-294/302 family synergistically blocks let-7-induced silencing of self-renewal in embryonic stem cells.

The embryonic stem cell (ESC)-enriched miR-294/302 family and the somatic cell-enriched let-7 family stabilizes the self-renewing and differentiated cell fates, respectively. The mechanisms underlying these processes remain unknown. Here we show that among many pathways regulated by miR-294/302, the combinatorial suppression of epithelial-mesenchymal transition (EMT) and apoptotic pathways is sufficient in maintaining the self-renewal of ESCs. The silencing of ESC self-renewal by let-7 was accompanied by the upregulation of several EMT regulators and the induction of apoptosis. The ectopic activation of either EMT or apoptotic program is sufficient in silencing ESC self-renewal. However, only combined but not separate suppression of the two programs inhibited the silencing of ESC self-renewal by let-7 and several other differentiation-inducing miRNAs. These findings demonstrate that combined repression of the EMT and apoptotic pathways by miR-294/302 imposes a synergistic barrier to the silencing of ESC self-renewal, supporting a model whereby miRNAs regulate complicated cellular processes through synergistic repression of multiple targets or pathways.

Characterization of the hepatitis B virus EnhI enhancer and X promoter complex.

The hepatitis B virus EnhI enhancer element overlaps the promoter of the X gene. By performing methylation interference experiments, four protein factor binding sites clustered in a 120-bp region were found to control the EnhI enhancer and X promoter activities. Deletion mapping experiments indicated that the two upstream protein factor binding sites constituted a basal enhancer module. This module, likely bound by a liver-specific factor and a ubiquitous factor, could activate the herpes simplex virus thymidine kinase gene promoter by 5- or 10-fold, depending on the orientation, in Huh7 cells, a liver-derived cell line, but not in other cell types tested. The two downstream protein factor binding sites interact with the upstream basal enhancer module in an orientation- and distance-dependent manner to increase the enhancer activity by another 10-fold. In addition, at least one of the two downstream protein factor binding sites is also essential for the X promoter activity.

Leaky transcription termination produces larger and smaller than genome size hepatitis B virus X gene transcripts.

The genomic DNA of hepatitis B virus (HBV) is circular and has only one known transcription termination site. The HBV X protein coding sequence is flanked by this transcription termination site at the 3' end and a promoter element at the 5' end. Transcription initiating from the X promoter and terminating at the termination site would produce a transcript 0.7 kb in length, which we have detected in cell lines that produce HBV particles. Unexpectedly, a 3.9-kb transcript containing two copies of the X gene sequence was also detected in these cell lines. Polymerase chain reaction analysis indicates that this 3.9-kb transcript contains sequences from both upstream and downstream of the termination site. Thus, transcription of this 3.9-kb transcript initiates from the X promoter, reads through the termination site, and terminates the second time it encounters the site. Analysis using an SV40-derived vector indicates that the transcription termination site in the HBV genome is also leaky for X gene transcription when a heterologous promoter initiates the transcription. Based on these results, the mechanism of how the transcription termination of HBV mRNA is regulated is discussed.