[Revision rate of periprosthetic joint infection post total hip or knee arthroplasty of 34 hospitals in China between 2015 and 2017: a multi-center survey].

Objective: To investigate the rate of periprosthetic joint infection (PJI) revision surgeries and clinical information of hip-/knee- PJI cases nationwide from 2015 to 2017 in China. Methods: An epidemiological investigation. A self-designed questionnaire and convenience sampling were used to survey 41 regional joint replacement centers nationwide from November 2018 to December 2019 in China. The PJI was diagnosed according to the Musculoskeletal Infection Association criteria. Data of PJI patients were obtained by searching the inpatient database of each hospital. Questionnaire entries were extracted from the clinical records by specialist. Then the differences in rate of PJI revision surgery between hip- and knee- PJI revision cases were calculated and compared. Results: Total of 36 hospitals (87.8%) nationwide reported data on 99 791 hip and knee arthroplasties performed from 2015 to 2017, with 946 revisions due to PJI (0.96%). The overall hip-PJI revision rate was 0.99% (481/48 574), and it was 0.97% (135/13 963), 0.97% (153/15 730) and 1.07% (193/17 881) in of 2015, 2016, 2017, respectively. The overall knee-PJI revision rate was 0.91% (465/51 271), and it was 0.90% (131/14 650), 0.88% (155/17 693) and 0.94% (179/18 982) in 2015, 2016, 2017, respectively. Heilongjiang (2.2%, 40/1 805), Fujian (2.2%, 45/2 017), Jiangsu (2.1%, 85/3 899), Gansu (2.1%, 29/1 377), Chongqing (1.8%, 64/3 523) reported relatively high revision rates. Conclusions: The overall PJI revision rate in 34 hospitals nationwide from 2015 to 2017 is 0.96%. The hip-PJI revision rate is slightly higher than that in the knee-PJI. There are differences in revision rates among hospitals in different regions.

[Progress in research on tumor immune PD-1/PD-L1 signaling pathway in malignant bone tumors].

Programmed death receptor 1 (PD-1) and its ligand PD-L1 have been shown to play an important role in evading the immune system. In recent years, PD-1/PD-L1 blockade has shown significant clinical effects in many malignancies, including malignant melanoma, renal cell carcinoma, classic Hodgkin lymphoma, non-small cell lung cancer and so on. PD-1/PD-L1 signaling pathway has become a new target of immunotherapy in patients with malignant tumors. However, there are few researches on immunotherapy in malignant bone tumors, and the progress of clinical research on PD-1/PD-L1 remains to be elucidated. This review started from the mechanism of PD-1/PD-L1 signaling in tumor immunity, and analyzed the application prospect of PD-1/PD-L1 antibodies in malignant bone tumors. We hope to provide a theoretical basis for the treatment of malignant bone tumors based on PD-1/PD-L1 signaling pathway in China.

[Early functional recovery of direct anterior approach versus anterolateral approach for total hip arthroplasty].

OBJECTIVE: To evaluate the early clinical effects of direct anterior approach (DAA) versus anterolateral approach (ALA) on safety and functional recovery following total hip arthroplasty (THA). METHODS: Between January 2015 and May 2016, a randomized clinical trial was performed at Guizhou Provincial People's Hospital. A total of 50 patients who underwent THA were allocated for either the DAA (n=25) or ALA (n=25). DDA group had 25 patients (25 hips), including 16 males and 9 females, with the mean age of (62±2) years, BMI of (23.26 ±4.95) kg/m2(range: 19.6 to 29.5), and preoperative Harris score of (33.4 ±15.5) (range: 17.9 to 48.9). Eleven cases were diagnosed as primarily hip osteoarthritis, 4 were developmental dysplasia of the hip (DDH, Crowe 2) and 10 were hip avascular necrosis (AVN, Stages 3 to 4). ALA group had 25 patients (25 hips), including 18 males and 7 females, with the mean age of (59±3) years, BMI of (25.35 ±5.8) kg/m2(range: 18.2 to 29.8), and preoperative Harris score of (38.6 ± 16.7) (range: 23.1 to 56.5). Ten cases were diagnosed as primarily hip osteoarthritis, 3 were developmental dysplasia of the hip (DDH, Crowe 2) and 12 were hip avascular necrosis (AVN, Stages 3 to 4). Operation time, incision length, intra-operative blood loss and functional recovery of hip postoperatively were compared between the two groups. RESULTS: The surgical incision of both groups were stage I healing. The mean follow-up was 6 months. There was no significant difference regarding operation time, incision length, and intra-operative blood loss between the two groups. However, we also found that there was no significant difference in the Harris score 3 months and 6 months postoperatively. In addition, two patients in ALA group suffered claudication (physical examination: abduction dysfunction of hip). We also found that DAA group resulted in better recovery of abductor strength and gait than ALA group during early follow-up. CONCLUSION: Both DAA and ALA could obtain good results of early curative effect following THA. Moreover, DAA resulted in better gait than ALA during early follow-up.

[An analysis of biochemical markers of bone metabolism in patients with idiopathic benign paroxysmal positional vertigo].

Objective:To analyze the biochemical markers of bone metabolism in patients with idiopathic benign paroxysmal positional vertigo（iBPPV）. Method:The study included 38 patients with iBPPV. Thirty-two healthy persons were collected as control group. Routine history collection, physical examination, and diagnosis were recorded in case group. Both the case group and control group were assessed for the status of bone biochemical markers. Result:①Among the 38 patients with iBPPV, posterior semicircular canal BPPV in right ear（R-PC-BPPV）presented in 23 cases , left ear（L-PC-BPPV）in 9 cases, horizontal semicircular canal BPPV in right ear in 2 cases, and in left ear in 2 cases, horizontal semicircular canal cupulolithiasis in 2 cases. ②The value of osteocalcin(OC), 25 hydroxyvitamin D3ï¼»25(OH)D3ï¼½, amino terminal propeptide of type I procollagen (PINP) in case group were lower than the normal reference value, and also significantly lower than that in the control group,OC: t=-2.013, P=0.048; 25(OH)D3: t=-2.133，P=0.037; PINP: t=-2.615,P=0.011. There was no significant difference of ß-isomerized carboxy-terminal telopeptide of type I collagen (ß-CTx) between the case group and control group. ③The value of OC(t=-2.187，P=0.035), 25(OH)D3(t=-2.190，P=0.035) and PINP(t=-2.322，P=0.026) in patients lower than 50 years old were significantly lower than that in the control group. The difference of these biochemical markers between the case and control group was not significant when subjects were ≥50 years old. Conclusion:The biochemical markers of bone metabolism in patients with iBPPV are declined, especially in patients lower than 50 years old. There may be abnormal bone metabolism in iBPPV patients.

Labour patterns in Chinese women in Chongqing.

OBJECTIVE: To obtain data on the characteristics of labour from a regional sample of Chinese parturients and to assess the pattern of progress of labour among nulliparous women. DESIGN: A prospective observational study. SETTING: The study was conducted in the First Affiliated Hospital of Chongqing Medical University. POPULATION: The final sample involved 1200 Chinese parturients with singleton, vertex and term gestation; spontaneous onset of labour; vaginal delivery; and without adverse perinatal outcomes. METHODS: A repeated-measures analysis was used to depict labour curves while an interval-censored regression was used to estimate the duration of labour centimetre by centimetre. MAIN OUTCOME MEASURES: Labour curves and the duration of labour at the 50th and 95th percentiles. RESULTS: Among 1091 nulliparous women, 57.7% had cervical dilation of 3 cm or less at the time of admission, and the mean duration of the first stage of labour was 9.1 ± 3.3 hours. From 5 to 9 cm of cervical dilation it sometimes took more than 2 hours for dilation to advance 1 cm. No obvious inflection points appeared in the labour curve of Chinese nulliparae, and no deceleration was observed. CONCLUSION: Progress of labour in Chinese parturients was more gradual than in their Western counterparts. Obstetric practice standards based on data generated from Western countries may not be appropriate for Chinese women. TWEETABLE ABSTRACT: A prospective study has evaluated labour patterns in Chinese women using regional data from nulliparae.

Mechanism of BMP and TG2 in mesenchymal stem cell osteogenesis.

OBJECTIVE: To study the interactive effects of Type II glutamine transaminase (TG2) and bone morphogenetic protein-9 (BMP-9) in the induction of osteogenesis in mice mesenchymal stem cells (MSCs) C3H10T1/2 model. MATERIALS AND METHODS: Batches of MSCs C3H10T1/2, divided into two groups, were treated with BMP-9 (control group) or BMP-9 and TG2 (experimental group) under oxygen deficient conditions. The secreted alkaline phosphatase (SEAP) chemiluminescence and the histochemical staining methods were used to detect the alkaline phosphatase (ALP) expression. The alizarin red S staining was used to detect the calcium salt precipitation and the caspase-3 protein expression was monitored using Western blot. Flow cytometry was employed to identify cell cycle, and trypan blue exclusion method to count the living cells and monitor cell proliferation. RESULTS: The levels of ALP expression in the experimental group were much higher than that of the control group. The level of expression of advanced caspase-3 protein was significantly lower (p < 0.05) in the experimental group than in the control group. The highest fraction of cells in the experimental group was in the phase M while cells in the control group were in the interphase. Moreover, cell number in the experimental group was significantly increased (p < 0.05) relatively to the control group. CONCLUSIONS: BMP-9 interacts with TG2 in osteogenesis of MSCs C3H10T1/2 cells. Further studies are needed to understand the exact mechanism of BMP9/PG2 interactions in osteogenesis.

Low energy-consumption plasma electrolytic oxidation based on grid cathode.

Plasma electrolytic oxidation (PEO) has attracted widespread attention owing to the simplicity of operation and the excellent properties of the formed coating. However, wider applications of PEO have been limited due to the high power consumption. This work describes the design and performance of a novel technique named shorter distance PEO (SD-PEO), which is intended for lowering the energy consumption. The key feature of the method is the application of grid cathode to eliminate the gaseous envelope effect and to block of the exchange of charge carries during SD-PEO process. Compared to PEO carried out at a normal electrode distance, e.g., 50 mm, both the voltage drop and the joule heat consumed in the electrolyte at a shorter distance, e.g., of 5 mm (SD-PEO) are relatively small. Consequently, the energy consumption rendered by the novel SD-PEO method may decrease by more than 25%. Our results reveal that SD-PEO is a low energy-consumption microarc oxidation technique with more potential in industry applications.

Prevention of neuropathic pain in an animal model of spare nerve injury following oral immunization with recombinant adenovirus serotype 5-mediated NR2B gene transfer.

Spinal N-methyl-D-aspartate receptor 2B subunit (NR2B)-increased expression plays an important role in the facilitation and maintenance of the persistent pain state due to peripheral nerve injury. A vaccination strategy to reduce the expression of brain protein is feasible and may have therapeutic potential for neurological disorders. Thus, we investigated the effect of oral immunization with recombinant adenovirus serotype 5-mediated NR2B gene transfer (rAd5/NR2B) for the modulation of neuropathic pain. After peroral administration of the rAd5/NR2B vaccine, transgene NR2B expression persisted for at least a week and was associated with the induction of high serum titers of NR2B-specific antibodies. Following the occurrence of mechanical allodynia due to peripheral nerve injury, NR2B-specific antibodies could pass the blood-brain barrier, transport and subsequently bind to the spinal NR2B protein. The humoral immunoresponse results in the strong antiallodynia in the spared nerve injury animal model. These data proved the feasibility of oral immunization with rAd5/NR2B for the prevention of neuropathic pain.

Antithrombogenic investigation of surface energy and optical bandgap and hemocompatibility mechanism of Ti(Ta(+5))O2 thin films.

Recent improvements in the antithrombogenic properties of blood contacting biomaterials permit a hybrid design of layers for biomedical applications such as artificial heart valves and stents. Using magnetron sputtering and thermal oxidation, titanium oxide thin films containing tantalum. Ti(Ta(+5))O2, are fabricated to meet the challenge of enhanced hemocompatibility. The blood compatibility is evaluated in vitro by clotting time and platelet adhesion measurement, and in vivo experiments are also conducted. The Ti(Ta(+5))O2 films exhibit attractive blood compatibility exceeding that of low isotropic pyrolytic carbon. Physical properties such as surface energy and semiconductivity are found to play important roles. Our calculated results reveal that the smaller surface force gamma(s) of the film and the smaller blood film interfacial tension gamma(c,blood) are partially responsible for the enhancement of the blood compatibility. Based on the optical bandgap model, the film possesses better hemocompatibility because its optical bandgap of 3.2 eV is wider than that of fibrinogen having a bandgap of 1.8 eV. These factors result in thinner protein layers on the film surface, less protein denaturing, and overall excellent antithrombogenic properties.