Ion-imprinted chitosan prepared without cross-linking agent for efficient selective adsorption of Al(III) from rare earth solution.

In the aqueous phase, ion-imprinted materials exhibit excellent selective adsorption properties for specific ions, but their complicated preparation process and large amount of crosslinker consumption limit their application. In this study, ion-imprinted chitosan (IIP-CS) was prepared by a simple one-step hydrothermal method without a cross-linking agent for the efficient adsorption of trace amounts of Al(III) from a rare earth solution. The structures and morphology of IIP-CS were analyzed by FT-IR, SEM, and XRD. The Al(III) adsorption characteristics of IIP-CS were investigated under various preparation processes and adsorption conditions. It was found that the optimum mass ratio of IIP-CS is 3 : 1 and pH is 3 and the adsorption capacity reaches up to 40.36 mg g-1. In addition, three different isothermal models-Temkin, Freundlich, and Langmuir-were used to analyze the equilibrium adsorption of IIP-CS in aqueous solution. The results obtained are consistent with the Langmuir model. The adsorption process of Al(III) on IIP-CS follows a pseudo-secondary kinetic model, suggesting that electron sharing or exchange between IIP-CS and Al(III) is a key factor affecting its adsorption rate. IIP-CS shows high selectivity coefficients for Al(III) in mixtures of La(III), Y(III), and Gd(III), which are 792.50, 163.26, and 55.16, respectively. The mechanism of action is the formation of a complex via amidation between Al(III) and IIP-CS. IIP-CS is an adsorbent with excellent regeneration and selective adsorption performance in aqueous solution.

Water Leaching Kinetics of Boron from the Alkali-Activated Ludwigite Ore.

The primary aim of this study was to investigate the boron leaching process from alkali-activated ludwigite ore. Initially, the ore underwent activation through roasting at 1050 °C for 60 min with 20% sodium carbonate. Subsequently, the study examined the influence of leaching parameters, including temperature, time, liquid-to-solid ratio, and particle size, using the activated ore as the raw material. Additionally, water leaching characteristics of the residues and boron kinetics were analyzed. The results demonstrated that boron leaching efficiency reached 93.71% from the reduced ludwigite ore under specific conditions: leaching temperature of 180 °C, leaching time of 6 h, liquid-to-solid ratio of 8:1, and feed particle size of 52.31 µm (average particle size). Leach residue characteristics indicated the dissolution of minerals during the process. The boron behavior during water leaching followed the Avrami Equation, and the kinetics equation was derived by fitting the leaching data. Moreover, the activation energy (Ea) value for boron leaching was determined to be 8.812 kJ·mol-1 using the Arrhenius Equation, indicating that the leaching process is controlled by diffusion.

Three-dimensional femur morphology analysis for the optimal location of subtrochanteric osteotomy with an implanted Wagner cone stem in total hip arthroplasty for Crowe type IV developmental dysplasia of the hip.

BACKGROUND: This study aimed to accurately evaluate the matching of proximal and distal femoral segments and fitting of the femur-femoral stem in patients with Crowe type IV developmental dysplasia of the hip (DDH) who have undergone subtrochanteric osteotomy at different locations with an implanted Wagner cone stem to improve the rate of the bone union at the osteotomy site. METHODS: Three-dimensional femur morphology of 40 patients with Crowe type IV DDH was evaluated at each cross-section to determine the femoral cortical bone area. This study focused on five osteotomy lengths (2.5, 3, 3.5, 4, and 4.5 cm). The overlapped area between the proximal and distal cortical bone segments was defined as the contact area (S, mm2), and the contact area to distal cortical bone area ratio was defined as the coincidence rate (R). Three indicators were used to evaluate the matching and fitting of the osteotomy sites with the implanted Wagner cone stems: (1) higher S and R between the proximal and distal segments; (2) the effective fixation length of the femoral stem at the distal segments being at least 1.5 cm; and (3) osteotomy did not involve the isthmus. RESULTS: In all groups, S significantly decreased in the two proximal levels above the 0.5 cm level below the lesser trochanter (LT) compared with those below this level. In comparison, at osteotomy lengths from 2.5 to 4 cm, R significantly decreased in the three proximal levels. The optimal osteotomy levels ranged from 1.5 and 2.5 cm below the LT for an appropriately sized stem. CONCLUSIONS: Subtrochanteric osteotomy at the optimal level not only ensures fitting of the femur-femoral stem but also meets the requirements of a higher S and R to ensure adequate reduction and stabilization at the osteotomy site, which may contribute to the bone union. Although the optimal osteotomy level varies with the size of the femoral stem and the length of the subtrochanteric osteotomy, the optimal osteotomy levels for an appropriately sized Wagner cone femoral stem implantation range from 1.5 to 2.5 cm below the LT.

Mid-Term Outcomes of Cemented Stem and Subtrochanteric Shortening Derotational Osteotomy in Total Hip Arthroplasty for Crowe IV Developmental Dysplasia.

OBJECTIVE: Performing subtrochanteric osteotomy with cemented components in patients with Crowe IV developmental dysplasia of the hip (DDH) is technically challenging and not widely reported. This study aimed to evaluate the mid-term outcomes of cemented stem total hip arthroplasty (THA) with subtrochanteric femoral shortening and transverse derotational osteotomy in patients with Crowe IV DDH. METHODS: Data collected from patients with Crowe IV DDH who underwent cemented stem THA with subtrochanteric femoral shortening and transverse derotational osteotomy between 2010 and 2018 were retrospectively evaluated. The cemented Lubinus SP II femoral component and the cementless CombiCup acetabular component were used together in all cases. These data, including Harris hip scores, limb length discrepancy (LLD), severity of limp, Trendelenburg test, bone union, length of the resected femur, limb lengthening, level of the osteotomy site, and length bridging the osteotomy site, as well as complications, were analyzed. A paired Student t-test was used to analyze continuous variables, categorical data were compared using Fisher's exact probability test, and correlation analysis was performed using Spearman's rank correlation coefficient. RESULTS: Among 14 included patients (10 females and four males), the mean age was 60.4 years (range, 47-73). The mean follow-up period was 49.1 months, and no patient was lost to follow-up. The mean Harris hip score improved from 40.7 to 87.7. The mean LLD decreased from 52 to 12.7 mm. The mean length of the excised femoral segment was 38.4 mm, and the mean length of limb lengthening was 27.1 mm. The mean distance between the osteotomy site and the lesser trochanter was 21.1 mm after surgery. The mean length of the femoral stem bridging the osteotomy site was 97.6 mm. Finally, the mean osteotomy union time was 10.6 months. No statistically significant correlation was found between the osteotomy union time and these factors. No neurological deficits were noted. Delayed union was observed in one patient, and postoperative dislocation was observed in two patients. Cement leakage into the osteotomy gap was observed in one patient, however, no revisions were required, and no signs of loosening or migration were observed. CONCLUSIONS: Cemented stem THA combined with subtrochanteric femoral shortening and transverse derotational osteotomy is safe and effective in treating patients with Crowe IV DDH. Rather than leading to nonunion, cement leakage may negatively affect bone healing.

The impact of novel anchored barbed suture for capsular closure on hospital length of stay after total knee arthroplasty: a retrospective cohort study.

OBJECTIVE: The aim was to evaluate whether using novel anchored barded suture for capsular closure can further shorten the length of stay following primary total knee arthroplasty (TKA) within existed enhanced recovery after surgery (ERAS) protocol in osteoarthritis patients. METHODS: A retrospective cohort study was conducted among osteoarthritis patients aged 18 to 80 years without major comorbidities who underwent primary unilateral TKA between January 2018 and December 2019 was conducted. The capsular closure techniques, interventions for ERAS, operation time and length of stay were collected via hospital electronic information system. Propensity-score matching was used to compensate for the difference in interventions for ERAS and patient characteristics. Subgroup comparison of patients treated under normal ERAS protocol was performed. RESULTS: Included were 315 patients with capsular closure by barded suture and 397 patients with interrupted capsular closure by traditional suture. Patients' characteristics and interventions for ERAS were balanced after propensity-score matching. The average postoperative length of stay in barded suture group was shorter than the compared group (2.10 ± 0.57 vs. 2.33 ± 0.80 days, p = 0.004), and with a significantly higher proportion of patients discharging within 2 days post procedure (88.0% vs. 70.7%, p < 0.001). The operation time for patients with barded suture closure was shorter compared to interrupted closure technique (100.90 ± 16.59 vs. 105.52 ± 18.47 min, p = 0.004). Subgroup analysis of patients treated under different levels ERAS protocol showed comparable results. CONCLUSION: The use of barded suture for capsular closure was associated with shorter length of stay after TKA compared to traditional suture, suggesting that barded suturing technique could be one effective intervention for ERAS.

Pseudotumor and delayed recurrent dislocation after total hip arthroplasty with a modular femoral neck: A case report.

RATIONALE: Pseudotumor formation after hip arthroplasty is a rare complication that can occur not only at the head-neck junction but also at the modular neck-stem junction. Dislocation is a challenging and common complication of primary and revision total hip arthroplasty compared with other complications. Similarly, the association between pseudotumors and delayed recurrent dislocation remains unclear. PATIENT CONCERNS: We report the case of a 73-year-old woman with pseudotumor formation after total hip arthroplasty combined with a modular femoral neck. A delayed recurrent dislocation occurred in this case. Approximately 4weeks after the first revision surgery, redislocation occurred. DIAGNOSIS: The patient was eventually diagnosed with delayed recurrent artificial hip dislocation combined with a periprosthetic pseudotumor of the right hip. INTERVENTIONS: During the first revision surgery, a thickened, indurated cyst measuring 8×3×8cm with a red-brown wall containing brown fluid was completely excised. A cemented stem, combined with a BIOLOX Forte ceramic head, was implanted. Approximately 4weeks after surgery, redislocation occurred, and we cemented an elevated rim liner on the acetabular component with a metal head. OUTCOMES: At the last follow-up, 49 months after revision surgery, the patient was asymptomatic with a Harris hip score of 90. The patient had a satisfactory prognosis after treatment. LESSONS: The application of the modular-neck stem should be cautiously performed, particularly for modular prostheses containing different alloys. Pseudotumors and insufficient soft-tissue tension both contribute to hip instability, which may eventually lead to delayed repeated dislocation. In addition, femoral offset must be considered. Cement-liner technology may be used for aging patients who are less active. This case report, focusing on pseudotumors and delayed recurrent dislocations, aimed to identify factors that may support this diagnosis, which is easy to miss. Consequently, it can provide further details on the treatment process and alert orthopedic surgeons to this infrequent but important cause of delayed recurrent dislocation.

Intra-articular injections of platelet-rich plasma vs. hyaluronic acid in patients with knee osteoarthritis: Preliminary follow-up results at 6-months.

The aim of the present study was to compare the clinical and economic benefits of intra-articular injections of platelet-rich plasma (PRP) and hyaluronic acid (HA) in Chinese patients with knee osteoarthritis (OA). A total of 86 patients (42 treated with PRP and 44 with HA) were treated with three weekly intra-articular injections. The inclusion criteria included patients between 18 and 75 years of age, with chronic knee pain or swelling lasting >3 months and X-ray findings of degenerative joint alterations according to the Kellgren-Lawrence score grade I-III. Clinical examinations were performed before treatment, at 1- and 6-month post-injection intervals. International Knee Documentation Committee subjective, Western Ontario and McMaster Universities and visual analogue scale scores were determined at each examination. Adverse reactions, average cost, treatment time and patient satisfaction were also recorded. Compared with patients injected with HA, PRP was found to be associated with increased and more severe post-injection pain and swelling, where the duration of adverse reactions was greater in the PRP group (P=0.02). During the follow-up evaluations, both groups showed statistically significant improvements in all clinical scores from pre-injection to 1- and 6-month assessments (P<0.05). However, no significant inter-group (PRP vs. HA) differences were observed in the clinical scores between the two follow-up time points. There were also no significant differences in clinical score between the groups with regards to the Kellgren-Lawrence grade I, II or III. The average cost of PRP injections was 22.8X that of HA administration and the average treatment time was 5X that of HA, but there was no significant difference in patient satisfaction. These preliminary results indicate that although PRP injections can significantly improve clinical outcome in patients with knee OA, PRP is not any more effective compared with HA. Furthermore, PRP injections are associated with higher costs and treatment times. Therefore, additional clinical studies are required before PRP injections can be considered as a first-line treatment option for knee OA.

A comprehensive program for enhanced management of femoral neck fractures including an enhanced recovery after surgery program: A retrospective study.

ABSTRACT: To retrospectively analyze the functional outcomes and complications in patients who underwent hip arthroplasty with enhanced recovery after surgery (ERAS) program for femoral neck fractures.Between June 2015 and May 2019, 1138 patients with femoral neck fractures were treated in our department. According to the Garden classification system, 467 cases were type III and 671 cases were type IV with an average age of 74.9 ±â€Š8.8 years (range, 59-96 years). All patients underwent hip arthroplasty with ERAS. The clinical outcomes of these patients were retrospectively analyzed at the final follow-up using the Harris hip score (HHS).The median follow-up was 21.2 months (range, 6-36 months). The mean time to surgery and the length of hospitalization after surgery were 2.4 and 2.2 days, respectively. Eight hundred and fifty-two patients (74.9%) were operated within 48 hours from admission, 1052 cases (92.4%) were discharged within 48 hours after surgery. Twelve patients (1.05%) were readmitted for prosthetic dislocation. None of the patients suffered from infection, periprosthetic fractures, and/or prosthetic loosening. The HHS at the final follow-up was 92.7 ±â€Š7.6, with an excellent or good rate of 90.2%.Patient-oriented ERAS optimizes the interventional measures during the perioperative period for geriatric patients with femoral neck fractures and can improve their short-term clinical outcomes without increased readmission rates.

Facile preparation of MoS2@Kaolin composite by one-step hydrothermal method for efficient removal of Pb(II).

MoS2@Kaolin was prepared by facile one-step hydrothermal method for the efficient adsorption of Pb(II) from aqueous solution. XRD, TG, SEM, BET, XPS and FTIR were used to characterize the phase and structure of composite before and after the adsorption of Pb(II). The results showed that MoS2 nanosheets were successfully assembled on kaolinite surface to form MoS2@Kaolin, and the adsorption capacity of the MoS2@Kaolin is 1.74 and 16.95 times than that of single MoS2 and kaolinite, respectively. MoS2@Kaolin composite exhibited a fast adsorption rate for Pb(II) and an excellent adsorption efficiency for Pb(II) in a wide pH range (2-5.5). The adsorption process followed the Langmuir isotherm model and maximum adsorption capacity was 280.39 mg/g. The adsorption kinetics of MoS2@Kaolin composite to Pb(II) fitted well with the pseudo-second-order kinetics models, which showed that the adsorption process was controlled by chemical sorption. MoS2@Kaolin showed excellent regeneration and maintained high selectivity adsorption with co-existence metal ions. The adsorption mechanism was that the Pb(II) reacted with the S atoms on surface of MoS2@Kaolin under oxidation conditions provided by molybdenum disulfide to form the insoluble compound ß-Pb3O2SO4 in aqueous solution. MoS2@Kaolin was an adsorbent for Pb(II) in aqueous solution with excellent adsorption properties and application potential.

Truncated Face-Rotating Polyhedra Constructed from Pentagonal Pentaphenylpyrrole through Graph Theory.

Discovering novel families of molecular polyhedra through graph theory has attracted increasing interest. Nevertheless, the design principles of molecular polyhedra based on graph theory remain elusive, especially for those containing five-node units. Herein, we construct a series of chiral truncated face-rotating polyhedra (T-FRP) from pentagonal pentaphenylpyrrole (PPP) derivatives and chiral diamines. Graph theory is used to elucidate the geometry of these novel T-FRP, which represent a new family of molecular polyhedra. The phenyl flipping of PPP faces in these T-FRP is significantly restricted, thus making T-FRP chiral and strongly emissive in solution. In addition, T-FRP also generate circularly polarized luminescence. This study provides new insights into the rational design of novel molecular polyhedra through graph theory.

Optimal location of subtrochanteric osteotomy in total hip arthroplasty for crowe type IV developmental dysplasia of hip.

BACKGROUND: When reconstructing a hip with developmental dysplasia and high dislocation, sub-trochanteric shortening osteotomy is typically needed for placing the acetabular component in the appropriate anatomical position. However, the procedure can result in complications such as non-union of the osteotomy. We evaluated the contact area and the coincidence rate between the proximal and distal fragments at different femoral osteotomy levels and lengths. We then determined the optimal location of subtrochanteric femoral shortening transverse osteotomy in patients with unilateral Crowe type IV developmental dysplasia of the hip (DDH). The consistency between the proximal and distal segments was assessed as a possible predictive indicator of the union at the osteotomy site. METHODS: We retrospectively reviewed 57 patients with unilateral Crowe type IV DDH who underwent X-ray imaging of both hip joints. We labelled the inner and outer diameters of the circular ring as N (mm) and M (mm), respectively. We defined the overlapped area between the proximal and distal ring as contact area S (mm2), and the ratio of contact area to distal ring area as coincidence rate R. RESULTS: N varied from 9.8-15.2 mm and M varied from 20.7-24 mm, both demonstrated a decreasing trend in the proximal to distal direction. At osteotomy lengths ranging from 0.5-2 cm, there were no differences in S between the different levels of osteotomy in each group. At osteotomy lengths ≤2.5 cm, a significant higher coincidence rate was noted from 2 cm below the lesser trochanter to other positions below the level. At osteotomy lengths from 3 to 5.5 cm, a significantly higher coincidence rate was observed from the level of 1.5 cm below the lesser trochanter to other positions below the level. CONCLUSIONS: Our findings suggest that femoral shortening transverse osteotomy at the optimal subtrochanteric level can predictably increase the contact area and coincidence rate, which may contribute to the union at the osteotomy site. Considering the stability of the prostheses, it appears appropriate that osteotomy location should be shifted slightly distally. TRIAL REGISTRATION: Retrospectively registered.

[Fixed-bearing unicompartmental knee arthroplasty for medial compartmental knee osteoarthritis].

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.

Facile synthesis of homochiral compounds integrating circularly polarized luminescence and two-photon excited fluorescence.

A pair of novel chiral one-dimensional compounds with the general formula [Cd(NO3)2L2]·THF (where L is R- or S-2,2'-bis(methoxymethoxy)-6,6'-bis(4-pyridyl)-1,1'-binaphthyl) for the first time show circularly polarized luminescence, two-photon excited fluorescence, and second harmonic generation activity.

[Clinical outcome of enhanced recovery after surgery for hemiarthroplasty for the treatment of femoral neck fractures in elderly patients].

OBJECTIVE: To analyze and evaluate the clinical outcomes of enhanced recovery after surgery(ERAS) for hemiarthroplasty for the treatment of femoral neck fractures in elderly patients. METHODS: From January 2015 to December 2016, 466 patients with femoral neck fractures were admitted in our department. Among them, 154 patients were more than 80 years old, with an average age of (83.9±3.2) years old (ranged, 80 to 96 years old), including 27 males and 127 females. According to Garden classification system, 68 cases were type III and others were type IV. ERAS for hemiarthroplasty were performed for all the patients. The time before operation, blood transfusion rate, complications rate, lenth of stay and Harris score system were evaluated. RESULTS: Among 154 patients, 142 patients were followed up, with an average duration of 24.6 months(ranged, 14 to 38 months). Thirty-two patients (20.8%) completed the operation within 48 hours after admission, 67 patients(43.5%) completed the operation within 72 hours after admission, 76 patients(49.4%) discharged within 48 hours after operation, and the blood transfusion rate was 15.9%. One patient was re-hospitalized because of prosthetic dislocation. The re-hospitalization rate was 0.6%. No other patients were re-hospitalized because of superficial or deep infection or periprosthetic fracture. At the latest follow-up, the Harris hip score was 90.2±7.1, 106 patients got an excellent result, 23 good and 9 fair. CONCLUSIONS: ERAS for hemiarthroplasty can effectively shorten hospitalization time, relieve pain, reduce blood transfusion rate, reduce postoperative complications, and do not increase the readmission rate of elderly patients with femoral neck fracture, which can achieve good clinical efficacy.

Chiral molecular face-rotating sandwich structures constructed through restricting the phenyl flipping of tetraphenylethylene.

Chiral tetraphenylethylene (TPE) derivatives have great potential in chiral recognition and circularly polarized luminescence. However, they were mainly constructed through introducing chiral substituents at the periphery of the TPE moiety, which required additional chemical modifications and limited the variety of chiralities of products. Herein, we constructed a series of chiral face-rotating sandwich structures (FRSs) through restricting the phenyl flipping of TPE without introducing any chiral substituents. In FRSs, the complex arrangements of TPE motifs resulted in a variety of chiralities. We also found that non-covalent repulsive interactions in vertices caused the facial hetero-directionality of FRSs, and the hydrogen bonds between imine bonds and hydroxy groups induced excited-state intramolecular proton transfer (ESIPT) emission of FRSs. In addition, the fluorescence intensity of FRSs decreases with the addition of trifluoroacetic acid. This study provides new insights into the rational design of chiral assemblies from aggregation-induced emission (AIE) active building blocks through restriction of intramolecular rotation (RIR).

Hydroxysafflor Yellow A Attenuates the Apoptosis of Peripheral Blood CD4+ T Lymphocytes in a Murine Model of Sepsis.

Sepsis is generally considered as a severe condition of inflammation that leads to lymphocyte apoptosis and multiple organ dysfunction. Hydroxysafflor yellow A (HSYA) exerts anti-inflammatory and anti-apoptotic effects in infectious diseases. However, the therapeutic effect of HSYA on polymicrobial sepsis remains unknown. This study was undertaken to investigate the therapeutic effects and the mechanisms of action of HSYA on immunosuppression in a murine model of sepsis induced by cecal ligation and puncture (CLP). NIH mice were randomly divided into four groups: control group, sham group, CLP group, and CLP+HSYA group. HSYA (120 mg/kg) was intravenously injected into experimental mice at 12 h before CLP, concurrent with CLP and 12 h after CLP. The levels of circulating inflammatory cytokines, the apoptosis of CD4+ and CD8+ T lymphocytes, and protein expression of cytochrome C (Cytc), Bax, Bcl-2, cleaved caspase-9, and cleaved caspase-3 were examined. Plasma levels of IL-6, IL-10 and TNF-alpha as well as the apoptosis of CD4+ T lymphocytes were increased compared with sham group. These changes were accompanied by increases of pro-apoptotic proteins including Cytc, Bax, cleaved caspase-9, and cleaved caspase-3 and decreases of anti-apoptotic protein Bcl-2 in CD4+ T lymphocytes from mice undergoing CLP. In contrast, we fail to observe significant effect of HSYA on the apoptosis of CD8+ T lymphocytes in CLP-treated group. Of note, HSYA treatment reversed all above changes observed in CD4+ T lymphocytes, and significantly increased the ratio of CD4+:CD8+ T lymphocytes in CLP-treated mice. In conclusion, HSYA was an effective therapeutic agent in ameliorating sepsis-induced apoptosis of CD4+ T lymphocytes probably through its anti-inflammatory and anti-apoptotic effects.

A 3D navigation template for guiding a unilateral lumbar pedicle screw with contralateral translaminar facet screw fixation: a study protocol for multicentre randomised controlled trials.

INTRODUCTION: The incidence of lumbar disc degeneration disease has increased in recent years. Lumbar interbody fusion using two unilateral pedicle screws and a translaminar facet screw fixation has advantages of minimal invasiveness and lower costs compared with the traditional methods. Moreover, a method guided by a three-dimensional (3D) navigation template may help us improve the surgical accuracy and the success rate. This is the first randomised study using a 3D navigation template to guide a unilateral lumbar pedicle screw with contralateral translaminar facet screw fixation. METHODS AND ANALYSIS: Patients who meet the criteria of the surgery will be randomly divided into experimental groups and control groups by a computer-generated randomisation schedule. We will preoperatively design an individual 3D navigation template using CATIA software and MeditoolCreate. The following primary outcomes will be collected: screw angles compared with the optimal screw trajectories in 3D digital images, length of the wound incision, operative time, intraoperative blood loss and complications. The following secondary outcomes will be collected: visual analogue scale (VAS) for back pain, VAS for leg pain and the Oswestry Disability Index. These parameters will be evaluated on day 1 and then 3, 6, 12 and 24 months postoperatively. ETHICS AND DISSEMINATION: The study has been reviewed and approved by the institutional ethics review board of the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University. The results will be presented at scientific communities and peer-reviewed journals. TRIAL REGISTRATION NUMBER: ChiCTR-IDR-17010466.

The location of Modic changes in the lumbar spine: a meta-analysis.

PURPOSE: This meta-analysis was to study the location of Modic changes in the lumbar spine. METHODS: The electronic databases including MEDLINE, Web of science, Cochrane Central Register of Controlled Trials, OVID, CBM were searched. Relevant studies that described the patients with Modic Changes were included. Data were extracted and analysed using the version 12.0 STATA software. RESULTS: Thirty-one studies were selected and analyzed (2346 total patients). No significant differences of the incidence of MC were identified between superior and the inferior end plates adjacent to discs [RR = 1.04, 95 % CI (0.74, 1.53)], the same result was detected for the distribution of MC type I between L4/5 and L5/S1 [RR = 0.80, 95 % CI (0.64, 1.02)]. While lower lumbar spine (L4/5, L5/S1) had significant greater incidence of MC [RR = 0.20, 95 % CI (0.15, 0.25)], especially in L5/S1 [RR = 0.82, 95 % CI (0.72, 0.92)]. For MC type II, it also significantly appeared in L5/S1 [RR = 0.80, 95 % CI (0.67, 0.95), P = 0.010]. CONCLUSIONS: In this study, Modic Changes was more common in the lowest two levels, especially in L5/S1. Additionally, the sub-types (type I and type II) were also more likely to appear in L5/S1. It appeared that there existed a correlation between MC and biomechanics. And it seemed that local biomechanical stress might contributed to the distribution of MC and the conversion of type I to type II for the patients treated conservatively.

The relationship between weight change and risk of hip fracture: meta-analysis of prospective studies.

The relationship between weight change and risk of hip fracture is still controversial. We searched PubMed and Embase for studies on weight change and risk of hip fracture. Eight prospective studies were included. The weight loss studies included 85592 participants with 1374 hip fractures, and the weight gain studies included 80768 participants with 732 hip fractures. Weight loss is more likely a risk factor of hip fracture, with an adjusted RR (Relative Risk) (95% CI) of 1.84 (1.45, 2.33). In contrast, weight gain can decrease the risk of hip fracture, with an adjusted RR (95% CI) of 0.73 (0.61, 0.89). Dose-response meta-analysis shows that the risk of hip fracture is an ascending curve, with an increase of weight loss above the line of RR = 1; this trend is consistent with the results of forest plots that examine weight loss and hip fracture. For weight gain and risk of hip fracture, the descending curve below the line of RR = 1; this trend is consistent with the results of forest plots that examine weight gain and hip fracture. Our meta-analysis suggests that weight loss may be a risk factor for hip fracture and that weight gain may be a protective factor for hip fracture.

Minimum 4-year outcomes of cervical total disc arthroplasty versus fusion: a meta-analysis based on prospective randomized controlled trials.

The prevalence of cervical disc disease is high, and the traditional surgical method of anterior cervical discectomy and fusion (ACDF) carries with it the disadvantages of motion loss at the operated level, and accelerated adjacent level disc degeneration. Preliminary results of the efficacy and reoperative rate comparing TDA versus ACDF have been reported; however, the long-term outcomes of TDA versus ACDF still remain a topic of debate. This review was prepared following the standard procedures set forth by the Cochrane Collaboration organization, and preferred reporting items for systematic reviews and meta-analyses (PRISMA). The only studies included were randomized controlled trials with a minimum of 4 years of follow-up data. The meta-analysis included the neck disability index (NDI), visual analog scale (VAS) of neck and arm pain, SF-36 physical component scores (SF-36 PCS), over success, neurological success, work status, implant-related complications, and secondary surgery events. Four randomized controlled trials meet the inclusion criteria. The long-term improvement of NDI, VAS of neck and arm pain, SF-36 PCS, over success, and neurological success favored the TDA group. The TDA group also had a lower incidence of secondary surgery for both the index level (RR: 0.45 [0.28, 0.72]) and adjacent level (RR: 0.53 [0.33, 0.88]). In this meta-analysis of 4 included RCTs with a minimum 4 years of follow-ups, total disc arthroplasty showed improvements over ACDF as measured by the NDI, VAS of neck and arm pain, and SF-36 PCS.