Chinese expert consensus on the diagnosis and treatment of osteoporotic periarticular fracture of the shoulder in the elderly (version 2023) / 中华创伤杂志

Periarticular fracture of the shoulder is a common type of fractures in the elderly. Postoperative adverse events such as internal fixation failure, humeral head ischemic necrosis and upper limb dysfunction occur frequently, which seriously endangers the exercise and health of the elderly. Compared with the fracture with normal bone mass, the osteoporotic periarticular fracture of the shoulder is complicated with slow healing and poor rehabilitation, so the clinical management becomes more difficult. At present, there is no targeted guideline or consensus for this type of fracture in China. In such context, experts from Youth Osteoporosis Group of Chinese Orthopedic Association, Orthopedic Expert Committee of Geriatrics Branch of Chinese Association of Gerontology and Geriatrics, Osteoporosis Group of Youth Committee of Chinese Association of Orthopedic Surgeons and Osteoporosis Committee of Shanghai Association of Chinese Integrative Medicine developed the Chinese expert consensus on the diagnosis and treatment of osteoporotic periarticular fracture of the shoulder in the elderly ( version 2023). Nine recommendations were put forward from the aspects of diagnosis, treatment strategies and rehabilitation of osteoporotic periarticular fracture of the shoulder, hoping to promote the standardized, systematic and personalized diagnosis and treatment concept and improve functional outcomes and quality of life in elderly patients with osteoporotic periarticular fracture of the shoulder.

Construction of an evaluation scale for post competence of family doctors based on knowledge-skill-management model / 中华全科医师杂志

Objective:To construct an evaluation scale for post competence of family doctors based on knowledge-skill-management model.Methods:The evaluation dimensions and indicators for post competency of family doctors were preliminarily developed through literature review, internal group meeting and brainstorming, and in-depth interviews of experts. And 16 experts in the fields of general practice and health management were invited for 2 rounds of Delphi consultation from December 2020 to April 2021. A competency evaluation scale for family doctors based on the dimensions of knowledge, skills and management was finally constructed.Results:The age of the experts was (47.9±7.3) years with a working experience of (24.6±7.8) years. The Cronbach′s α of the questionnaires was 0.891 and the KMO was 0.844. The positive coefficients for 2 rounds of expert consultation were 100%; the familiarity level of experts was 0.86 and authority level was 0.89 in the first round consultation, and those were 0.84 and 0.90 in the second round consultation. After 2 rounds of consultation, the coordination coefficient of expert opinions in the knowledge and skill dimensions was>0.5, and that in the management dimension and overall evaluation system was>0.3. After discussion 2 indicators were deleted in the first round of consultation. The finally constructed family doctor post competency evaluation scale included 3 dimensions, 8 secondary indicators and 61 tertiary indicators. Conclusion:Through the Delphi consultation, we have successfully constructed an evaluation scale for post competence of family doctors based on the three dimensions of knowledge, skills and management.

Investigation on clinical knowledge and training needs of general practitioners: a perspective of subjective perception and objective assessment / 中华全科医师杂志

Objective:To analyze the clinical knowledge and training needs of general practitioners from subjective perception and objective assessment, and to analyze their relationship.Methods:A survey was conducted among general practitioners from community health service centers in Shanghai Changning district from September to December 2020. Based on the general practitioner competency indicator system designed by the project team, 17 clinical knowledge competency evaluation indicators were developed through expert consultation, and used for subjective perception and objective assessment of clinical knowledge and learning needs among general practitioners. The influencing factors of objective assessment scores were analyzed, and the relationship between subjective perception and objective assessment scores was analyzed using the four quadrant method.Results:A total of 136 general practitioners participated in the study with the mean age of (39.25±5.90) years, most of whom were attending physician (67.65%, 92/136) and had undergraduate education (88.20%, 122/136). The average daily application frequency score was (1.55±0.21), and the training needs score was (1.65±0.09) for 17 clinical knowledge items; the average objective evaluation score was (74.21±14.0) points. The older the age ( OR=1.25, 95% CI:1.14-1.37), the higher the educational level ( OR=2.11, 95% CI:1.57-2.83), and the longer the working years ( OR=1.16, 95% CI:1.04-1.30) were significantly correlated with the higher objective evaluation scores (all P<0.05). The objective evaluation scores of endocrine diseases such as diabetes, cerebrovascular diseases and respiratory diseases are the highest, and the daily application frequency and learning needs are high (the first quadrant); The objective evaluation scores of common orthopedic diseases, common psychological diseases, and planned immunity indicators were relatively low, but their daily application frequency and learning needs were relatively high (second quadrant). The objective evaluation scores of indicators such as common malignant tumors, common dermatology diseases and health problems, and common ENT diseases were low, and the daily application frequency and learning needs were also low (the third quadrant). The objective evaluation scores of indicators such as hospice and palliative care are relatively high, but their daily application frequency and training needs are relatively low (listed in the fourth quadrant). Conclusions:The clinical knowledge levels of general practitioners are correlated with age, education level, and years of practice. There is a certain overlap between the objective evaluation results of clinical knowledge and the frequency of knowledge usage and training needs of general practitioners, and a targeted training mechanism should be established.

The path and effect of regional medical centers and community centers in post-training of general practitioners with "integrated dual-drives" model / 中华全科医师杂志

The integration of regional medical centers and community health service centers is an effective way to improve the professional ability of general practitioners in post-practice training. Its major advantage lies in the establishment of a regional general practitioner ability improvement system integrating assessment, practice and teaching under the unified health administrative department. This article introduces the path of general practitioner post-training developed by Shanghai Tongren Hospital in forms of a regional medical center combined with the community health service center under the "integrated dual-drives" model, which was carried out in Shanghai Changning District; and its preliminary accomplishment is also discussed. It may provide reference for regional medical centers to improve the ability of general practitioners through practice-driven and teaching-driven.

A Novel Strategy for Regulating mRNA's Degradation via Interfering the AUF1's Binding to mRNA.

The study on the mechanism and kinetics of mRNA degradation provides a new vision for chemical intervention on protein expression. The AU enrichment element (ARE) in mRNA 3'-UTR can be recognized and bound by the ARE binding protein (AU-rich Element factor (AUF1) to recruit RNase for degradation. In the present study, we proposed a novel strategy for expression regulation that interferes with the AUF1-RNA binding. A small-molecule compound, JNJ-7706621, was found to bind AUF1 protein and inhibit mRNA degradation by screening the commercial compound library. We discovered that JNJ-7706621 could inhibit the expression of AUF1 targeted gene IL8, an essential pro-inflammatory factor, by interfering with the mRNA homeostatic state. These studies provide innovative drug design strategies to regulate mRNA homeostasis.

Design, synthesis, and evaluation of 9-(pyrimidin-2-yl)-9H-carbazole derivatives disrupting mitochondrial homeostasis in human lung adenocarcinoma.

Since more than 85% of lung cancer cases are non-small cell lung cancer (NSCLC), finding novel agents with anti-tumor activities is meaningful for NSCLC patients. Mitochondria is essential for cellular energy metabolism in cancer, and regulating mitochondrial bioenergetics is emerging as a practical approach for cancer treatment and prevention. The carbazole scaffold is an active structure showing anti-cancer biological activity, and the structural diversity has been expanded through the improvement and optimization of synthesizing methods. To find novel carbazole derivatives with great anti-tumor potential and explore structures variety, we designed and synthesized a series of 9-(pyrimidin-2-yl)-9H-carbazole derivatives based on the previously reported Cp∗Rh(III)/H+ tandem catalytic system. With thoroughly bioactivity exploration, we found benzo[d] [1,3]dioxol-5-yl(9-(pyrimidin-2-yl)-9H-carbazol-1-yl)methanone (compound 5n) showed notable activity in disrupting the mitochondrial homeostasis, induced cell cycle arrest and apoptosis in human adenocarcinoma cells, and finally showed anti-tumor activity in an NSCLC-xenograft mice model.

Green Synthesis of Leaning Tower[6]arene-Mediated Gold Nanoparticles for Label-Free Detection.

Here a facile synthesis strategy toward carboxylated leaning tower[6]arene (CLT6)-mediated gold nanoparticles (CLT6-AuNPs) without external energy sources and reducing agents has been developed. Due to the cavity structure of CLT6, CLT6-AuNPs with a controllable particle size show good stability and excellent performance in label-free detection of diquat. Significantly, we reveal the reduction mechanism of AuNP formation, which is the cleavage of some phenyl ether bonds of CLT6 to produce reductive phenols, thus reducing Au3+ to AuNPs.

Recent Progress in Solar-Induced Direct Biomass-to-Electricity Hybrid Fuel Cell Using Microalgae as Feedstocks.

Microalgae, as potential biodiesel feedstocks, have been widely reported to accumulate oil via genetic engineering techniques, or environmental stress regulation. Recently, the utilization of fuel cell technology to convert biomass into electricity has attracted much more attention due to its high efficiency, low pollution, low noise by microalgae as feedstocks. Normally, platinum and analogous noble metals as catalysts have been already demonstrated although they still exist lots of shortcomings. This mini review presents an overview of various fuel cell technologies with phosphomolybdic acid as catalysts for sustainable energy by using microalgae. Trends from literatures demonstrate that algal-based fuel cells could efficiently generate electricity, and concurrently produce high value-added products. This critical review can provide guiding suggestions for future study of algal-based energy conversion by fuel cell techniques.

TGF-β1-regulated miR-3691-3p targets / 亚洲男科学杂志(英文版)

Transforming growth factor-β1 (TGF-β1) acts as a tumor promoter in advanced prostate cancer (PCa). We speculated that microRNAs (miRNAs) that are inhibited by TGF-β1 might exert anti-tumor effects. To assess this, we identified several miRNAs downregulated by TGF-β1 in PCa cell lines and selected miR-3691-3p for detailed analysis as a candidate anti-oncogene miRNA. miR-3691-3p was expressed at significantly lower levels in human PCa tissue compared with paired benign prostatic hyperplasia tissue, and its expression level correlated inversely with aggressive clinical pathological features. Overexpression of miR-3691-3p in PCa cell lines inhibited proliferation, migration, and invasion, and promoted apoptosis. The miR-3691-3p target genes E2F transcription factor 3 (E2F3) and PR domain containing 1, with ZNF domain (PRDM1) were upregulated in miR-3691-3p-overexpressing PCa cells, and silencing of E2F3 or PRDM1 suppressed PCa cell proliferation, migration, and invasion. Treatment of mice bearing PCa xenografts with a miR-3691-3p agomir inhibited tumor growth and promoted tumor cell apoptosis. Consistent with the negative regulation of E2F3 and PRDM1 by miR-3691-3p, both proteins were overexpressed in clinical PCa specimens compared with noncancerous prostate tissue. Our results indicate that TGF-β1-regulated miR-3691-3p acts as an anti-oncogene in PCa by downregulating E2F3 and PRDM1. These results provide novel insights into the mechanisms by which TGF-β1 contributes to the progression of PCa.

Identification of Cross-Reactive CD8+ T Cell Receptors with High Functional Avidity to a SARS-CoV-2 Immunodominant Epitope and Its Natural Mutant Variants

Despite the growing knowledge of T cell responses and their epitopes in COVID-19 patients, there is a lack of detailed characterizations for T cell-antigen interactions and T cell functions. Using a peptide library predicted with HLA class I-restriction, specific CD8+ T cell responses were identified in over 75% of COVID-19 convalescent patients. Among the 15 SARS-CoV-2 epitopes identified from the S and N proteins, N361-369 (KTFPPTEPK) was the most dominant epitope. Importantly, we discovered 2 N361-369-specific T cell receptors (TCRs) with high functional avidity, and they exhibited complementary cross-reactivity to reported N361-369 mutant variants. In dendritic cells (DCs) and the lung organoid model, we found that the N361-369 epitope could be processed and endogenously presented to elicit the activation and cytotoxicity of CD8+ T cells ex vivo. Our study evidenced potential mechanisms of cellular immunity to SARS-CoV-2, illuminating natural ways of viral clearance with high relevancy in the vaccine development.

Gut microbial taxa as potential predictive biomarkers for acute coronary syndrome and post-STEMI cardiovascular events.

Plasma trimethylamine N-oxide (TMAO) is associated with coronary atherosclerotic plaque and cardiovascular disease risk, but associations between gut microbes in acute coronary syndrome (ACS) and post-ST-segment elevation myocardial infarction (post-STEMI) events are unknown. We investigated associations between gut microbial taxa and systemic TMAO levels and the possible TMAO contribution to incident post-STEMI cardiovascular events. PATIENTS AND METHODS: A total of 60 patients, including 30 with unstable angina pectoris (UAP), 30 post-STEMI and 30 healthy controls, were enrolled from June to November 2017. Metagenomic sequencing was performed and TMAO and IL-6 were detected. RESULTS: Minimal discriminators of gut microbial taxa (top 40) distinguished ACS patients from controls. Serum TMAO levels were positively associated with increased abundance of Aerococcaceae, Ruminococcaceae_UCG.005, Ruminococcaceae_UCC.014 and X. Eubacterium_fissicatena, and decreased abundance of Lachnospiraceae_FCS020 (P < 0.05). Elevated serum TMAO levels correlated independently with ACS (P < 0.05). Risk stratification for incident major adverse cardiovascular events (MACE) improved at one year in patients with serum TMAO levels ≦2.19 µM. Serum interleukin-6 levels were not significantly increased in patients with ACS and post-STEMI MACE. CONCLUSIONS: ACS and incident post-STEMI MACE may be associated with the gut bacteria choline metabolite TMAO. The specific gut microbial taxa identified in association with serum TMAO levels may be potential predictive biomarkers for accurate diagnosis of ACS onset.

Pathway of establishing continuing education mechanism for community general practitioner in regional medical centers / 中华全科医师杂志

Comprehensively and continuously improving the ability is the goal of continuing medical education for practicing general practitioners (GPs). It is urgent to carry out systematic planning for improvement of the training content, training methods and evaluation methods in current continuing education system. Therefore, based on the survey of the training requirements of the community GPs in Shanghai Changning District, this study proposed a pathway of establishing continuing education mechanism for community GPs in regional medical centers. This continuing education mechanism planned to build a talent evaluation system reflecting the competency of the community GPs, to develop training contents based on the community situation and the needs of the GPs, to establish the practice support and the collaboration platform of science, education and research, to promote the sustaining improvement of GPs.

Survey on competence and training needs of general practitioners from perspective of community health service institution managers / 中华全科医师杂志

Based on literature analysis and conference discussion, the index system of the competence and performance of general practitioners (GPs) was developed, which consisted of 4 dimensions and 59 indicators. Based on the indicator system, the questionnaire was designed. From March 2019 to May 2019, a questionnaire survey on the ability, performance and training needs of GPs was conducted among the managers of 10 community health service centers in Shanghai Changning District. The dependent variables were analyzed through descriptive analysis, correlation analysis and quadrant mapping methods. The median of overall evaluation score of the performance of GPs in 10 community health service center was 2.7(2.4,2.9); and the mean of training demand score was (1.4±0.5). The performance scores was negatively correlated with the degree of training needs ( r=-0.654, P<0.01). Among the 59 capacity assessment indicators, there were 25 (42.4%) with poor performance but high training demand. The overall ability of general practitioners was common from the perspective of the community health service center managers, suggesting that it is important to strengthen the capacity development for community GPs, and those with poor performance and high training needs should be included in training priority, such as disease diagnosis and treatment, emergency management ability, rehabilitation service ability and medical law.

Survey on clinical skill application and training needs of community general practitioners in Shanghai Changning District / 中华全科医师杂志

A survey on clinical skill application and training needs of general practitioners (GPs) was conducted in the community health service centers of Shanghai Changning District from March to May 2019. The heads of the medical/prevention departments of 10 community health service centers (CHS) in Changning District were invited to evaluate the application frequency of clinical skills and training needs of GPs. According to Residency Training Standards for General Practitioners (trial), Training Standards for Assistant General Practitioners (trial), Training Program for General Practitioners in Primary Medical and Health Institutions (trial), 369 clinical skills for general practitioners were included for evaluation. The application frequency of above 369 clinical skills among 198 general practitioners were evaluated and training needs were also assessed. The overall application frequency score of GPs for 369 clinical skills was 1.00 (0.30, 1.70) points, and the training needs score was 1.40 (1.10, 1.70) points. The application frequency of different clinical skills was positively correlated with training needs ( r=0.462, P<0.01). And the four-quadrant analysis results show that among the 369 clinical practice skills, 116 (31.4%) items were used by GPs with high frequency and high training needs, and 80 (21.7%) items were used with low frequency but high training needs. There were 45 (12.2%) items with high application frequency but low training needs, and 128 (34.7%) items with low application frequency and low training needs. The survey indicates that the training of clinical skills listed in the three major training standards or outlines should be strengthened in continuing education for general practitioners, and the practice skills with high application frequency and high training needs should be focused in training program to improve the quality, effectiveness and efficiency of training.

Survey on the needs of continuing medical education for general practitioners in Changning District, Shanghai / 中华全科医师杂志

From March 2019 to May 2019, panel interviews were conducted with 39 representatives of 10 community health service centers in Shanghai Changning District, each took 30 to 90 min. The relevant information of interviews was coded, classified, streamlined, and the interview topics were sorted out. The interviews showed the following problems of continuing education in community health care setting currently: there were lack of updated disease-related clinical guidelines and other knowledge, lack of uniform regulations on rational drug use; the contents or forms of training did not match the needs of the community; and training in psychology and nutrition therapy could not be transformed into practical application. The participants made the following suggestions for continuing medical education: to build a database of clinical guidelines for diseases; to provide information-based support and guidance for rational drug use; to design training contents and training forms based on community needs; to provide training support in psychology, nutrition and other subjects; to increase trainings in research, teaching and health management and other aspects. Continuing medical education for community general practioners faces problems from knowledge users, knowledge providers, and the policy environment. The contents and forms of training needs should be optimized. These can be strengthened by communicating with the community and following up with the needs of the community in establishing diversified training forms, supporting assessment and incentive mechanisms for different types of training contents.

Clinical analysis of tumor-related venous thromboembolism in elderly patients / 中华老年医学杂志

Objective:To investigate clinical features and risk factors for pulmonary embolism in elderly patients with tumor-associated venous thromboembolism(VTE).Methods:Patients aged ≥65 years with malignant tumors combined with deep venous thromboembolism(DVT)in our hospital from June 2014 to November 2018 were enrolled retrospectively.General information such as age, sex, date of hospitalization, primary tumor location, tumor metastasis, concomitant disease, thrombosis type and site were collected.The Charlson comorbidity index was calculated.According to the site of deep vein thrombosis, patients were divided into the DVT group and the pulmonary embolism(PTE)group.Risk factors for PE were analyzed statistically on the indicators in the two groups.Results:Of the 318 patients, 281(88.4%)were in the DVT group and 37(11.6%)were in the PE group.There were no statistically significant differences in age, sex, smoking history, length of hospital stay, primary tumor type or tumor metastasis between the two groups( P>0.05). The main comorbidities included hypertension, diabetes mellitus, atherosclerotic coronary disease, chronic obstructive pulmonary disease, heart failure, cerebrovascular disease, chronic kidney disease and chronic liver disease, and there was no statistically significant difference in the number of patients with the above diseases between the two groups( P>0.05). Charlson comorbidity index scores were higher in the PE group than in the DVT group(7.22±3.95 vs.5.69±2.89, P=0.028). Logistic regression analysis showed that age( OR=0.9, 95% CI: 0.846-0.985, P=0.001), tumor metastasis( OR=0.006, 95% CI: 0.001-0.032, P=0.000), and Charlson comorbidity index score( OR=2.278, 95% CI: 1.772-2.929, P=0.000)were all independent risk factors for PTE. Conclusions:Age, tumor metastasis and Charlson comorbidity index score are independent risk factors for PE in elderly tumor patients.

Overexpression of miR-30a Promotes Apoptosis of Leukemia K562 Cells / 中国实验血液学杂志

OBJECTIVE@#To investigate the pro-apoptotic effect and mechanism of miR-30a overexpression on chronic myeloid leukemia K562 cells.@*METHODS@#The k562 cells were transfected with the recombinant plasmid pEGFP-pre-miR-30a, the real-time quantitative PCR was used to detect the level of miR-30a and BCR/ABL, and then the cell apoptosis was assessed by flow cytometry with AnnexinV-FITC/PI double staining. Western blot was used to detect the expression of BCR/ABL protein,apoptosis-related protein BCL-2 and BAX, PTEN, AKT and p-AKT.@*RESULTS@#Sequencing and digestion map indicated that the recombinant plasmid was constructed successfully. Compared with 2 control groups, the miR-30a expression in k562 cells transfected with recombinant plasmid pEGFP-pre-miR-30a was obviously up-regulated. The expression of BCR/ABL mRNA and BCR/ABL protein was both significantly down-regulated. Apoptotic rate was significantly enhanced (both P<0.05),and the expression of anti-apoptotic protein BCL-2 was down-regulated while the expression of pro-apoptotic protein BAX was up-regulated. The level of PTEN was significantly up-regulated in omparison with control groups,no variation was found in total AKT, but the expression of p-AKT was down-regulated.@*CONCLUSION@#The overexpression of miR-30a is abled to down-regulate the level of BCR/ABL mRNA and BCR/ABL protein, and increase apoptotic rate, its mechanism may be related with inhibition of the activity of BCR/ABL-PTEN/AKT signaling pathway.

Fixed-bearing unicompartmental knee arthroplasty for medial compartmental knee osteoarthritis / 中国骨伤

OBJECTIVE@#To evaluate short-term clinical results of fixed-bearing unicompartmental knee arthroplasty (UKA) for patients with medial compartmental knee osteoarthritis.@*METHODS@#From January 2015 to December 2017, 62 patients with medial compartmental knee osteoarthritis were treated by fixed-bearing UKA. Among them, including 19 males and 43 females, aged from 47 to 83 years old with an average of (65.3±8.2) years old. The courses of disease ranged from 5 to 72 months with an average of(19.4±14.3) months. Postoperative complications were observed, VAS score was used to observe degree of pain relief, Hospital for Special Surgery(HSS) score was used to evaluate clinical effects.@*RESULTS@#All patients were followed up from 4 to 40 months with an average of(19.9 ±10.2) months. The incision healed well without blood transfusion, hospital stays ranged from 2 to 10 days with an average of (3.5±1.6) days. No deep infection, dislocation, loosing or per prosthetic fracture occurred after operation, while 1 patient suffered from posterior tibial vein thrombosis. HSS score improved from 69.9±7.2 before operation to 90.1±7.4 at final following-up, and 51 patients obtained excellent results, 9 patients good and 2 moderate. VAS score decreased from 3.8±0.9 before operation to 1.1±0.9 at final following-up.@*CONCLUSIONS@#Fixed-bearing UKA for medial compartmental knee osteoarthritis could obtain short-term clinical results for shorter hospital stay, less complications. with fewer complication and fast recovery.

Texture analysis of magnetic resonance T1 mapping with dilated cardiomyopathy: A machine learning approach.

The diagnosis of dilated cardiomyopathy (DCM) remains a challenge in clinical radiology. This study aimed to investigate whether texture analysis (TA) parameters on magnetic resonance T1 mapping can be helpful for the diagnosis of DCM.A total of 50 DCM cases were retrospectively screened and 24 healthy controls were prospectively recruited between March 2015 and July 2017. T1 maps were acquired using the Modified Look-Locker Inversion Recovery (MOLLI) sequence at a 3.0 T MR scanner. The endocardium and epicardium were drawn on the short-axis slices of the T1 maps by an experienced radiologist. Twelve histogram parameters and 5 gray-level co-occurrence matrix (GLCM) features were extracted during the TA. Differences in texture features between DCM patients and healthy controls were evaluated by t test. Support vector machine (SVM) was used to calculate the diagnostic accuracy of those texture parameters.Most histogram features were higher in the DCM group when compared to healthy controls, and 9 of these had significant differences between the DCM group and healthy controls. In terms of GLCM features, energy, correlation, and homogeneity were higher in the DCM group, when compared with healthy controls. In addition, entropy and contrast were lower in the DCM group. Moreover, entropy, contrast, and homogeneity had significant differences between these 2 groups. The diagnostic accuracy when using the SVM classifier with all these histogram and GLCM features was 0.85 ±â€Š0.07.A computer-based TA and machine learning approach of T1 mapping can provide an objective tool for the diagnosis of DCM.

Candida arthritis: 18 cases report and literature review / 中华骨科杂志

Objective To analyze the clinical features of candida arthritis and to conduct literature review to improve diagnosis and treatment.Methods From January 2008 to June 2018,eighteen patients (5 females and 13 males) with candida arthritis were admitted to two hospitals.The mean age at diagnosis was 59±8 (range 48-71 years).The diagnosis was determined based on joint fluid aspirate in all cases and on intra-operative samples in 1 patients.Seventeen patients received MR examination,and on epatient who underwent total knee arthroplasty underwent knee X-ray examination.The clinical features,risk factors,clinical manifestations,etiology,treatment and prognosis are recorded.Results Knee joints were involved in all patients as infection sites.Seventeen patients had risk factors for candida infection,including diabetes mellitus in 2 patients,artificial joint replacement in 1,and glucocorticoid injection in the joint cavity in 16.Swelling and pain were presented in all cases.Peripheral blood leukocytes were increased or normal,while C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were increased.Magnetic resonance showed joint effusion and slip membrane hyperplasia.Joint turbidity and synovial hyperplasia were presented by arthroscopy.X-ray demonstrated swelling of soft tissue around the prosthesis and bone absorption around the prosthesis.The most frequent species was non-candida albicans.Susceptibility to antifungals was tested in all cases.Thirteen patients underwent surgery combined with antifungal therapy,while 4 patients only received antifungal therapy and 1 patient refused to treat.The duration of antifungal therapy was from 6 weeks to 52 weeks (median,12 weeks).Twelve cases were treated with fluconazole and 1 with voriconazole,1 with voriconazole and fluconazole,1 with fluconazole combined with lipid formulation amphotericin B,1 with terbinatine and fluconazole,1 with flucytosine combined with tluconazole.Seventeen cases were followed up for 3 to 72 months.At final follow-up,twelve patients were healed,while 1 case was amputated and 4 patients relapsed and refused further treatment.Conclusion As a rare disease,candida arthritis is usually happened after artificial joint replacement and in high-risk patients with diabetes and immunosuppressant applications.In immunoeompetent patients without surgery,infection may be related to multiple injections into the joim cavity with glucocorticoids.The infection may be difficult to be diagnosed and with poor prognosis.Surgery with long-term antifungal therapy is required.