Study on the Role of Medical Social Work in Organ Donation after Citizen’s Death / 中国医学伦理学

The development of human organ transplantation technology has brought the hope of rebirth to countless patients with organ failure. Human organ donation and transplantation need the joint efforts of various levels of Red Cross societies, human organ procurement organizations, medical institutions, etc. Medical social workers, as new forces, are gradually playing their own role. By summarizing the professional advantages of medical social work in organ donation after citizen’s death, this paper proposed that medical social workers can provide professional services for donors and their families through practical work, such as clarifying their willingness to donate and providing crisis intervention services to their families, assisting them in completing donation matters and holding farewell ceremonies, and following up and carrying out grief counseling activities. Regarding the problems encountered in practice process, suggestions were proposed to expand the scale of medical social workers and improve their management, increase social awareness of medical social work, and provide all-round support for the implementation of later service.

Return to the Patient’s Nature / 中国医学伦理学

Medicine is essentially an anthropology, and the patient role is characterized by integrity and subjectivity. With the progress of science and technology and social development, the contemporary patient role has become alienated. The specific manifestations of patient role alienation were analyzed from four aspects, including the objectification of the patient role and the blurring of the patient boundaries in sociology, the objectification of the patient role and the indexing of patients’ pain in technology, the challenge of patient life and health rights and the alienation of informed consent rights in law, and the instrumentalization of patient role and the fragility of patient subjectivity in economics. This paper proposed that the coordination of technology and humanities, the return to the nature of patients, and the concern for the needs of patients are essential in the development of modern medicine.

Imprinted SARS-CoV-2 humoral immunity induces converging Omicron RBD evolution

Continuous evolution of Omicron has led to a rapid and simultaneous emergence of numerous variants that display growth advantages over BA. 5. Despite their divergent evolutionary courses, mutations on their receptor-binding domain (RBD) converge on several hotspots. The driving force and destination of such convergent evolution and its impact on humoral immunity remain unclear. Here, we demonstrate that these convergent mutations can cause striking evasion of neutralizing antibody (NAb) drugs and convalescent plasma, including those from BA.5 breakthrough infection, while maintaining sufficient ACE2 binding capability. BQ.1.1.10, BA.4.6.3, XBB, and CH. 1.1 are the most antibody-evasive strain tested, even exceeding SARS-CoV-1 level. To delineate the origin of the convergent evolution, we determined the escape mutation profiles and neutralization activity of monoclonal antibodies (mAbs) isolated from BA.2 and BA.5 breakthrough-infection convalescents. Importantly, due to humoral immune imprinting, BA.2 and especially BA.5 breakthrough infection caused significant reductions in the epitope diversity of NAbs and increased proportion of non-neutralizing mAbs, which in turn concentrated humoral immune pressure and promoted convergent evolution. Moreover, we showed that the convergent RBD mutations could be accurately inferred by integrated deep mutational scanning (DMS) profiles, and the evolution trends of BA.2.75/BA.5 subvariants could be well-simulated through constructed convergent pseudovirus mutants. Together, our results suggest current herd immunity and BA.5 vaccine boosters may not provide good protection against infection. Broad-spectrum SARS-CoV-2 vaccines and NAb drugs development should be highly prioritized, and the constructed mutants could help to examine their effectiveness in advance.

BA.2.12.1, BA.4 and BA.5 escape antibodies elicited by Omicron infection

SARS-CoV-2 Omicron sublineages BA.2.12.1, BA.4 and BA.5 exhibit higher transmissibility over BA.21. The new variants receptor binding and immune evasion capability require immediate investigation. Here, coupled with Spike structural comparisons, we show that BA.2.12.1 and BA.4/BA.5 exhibit comparable ACE2-binding affinities to BA.2. Importantly, BA.2.12.1 and BA.4/BA.5 display stronger neutralization evasion than BA.2 against the plasma from 3-dose vaccination and, most strikingly, from post-vaccination BA.1 infections. To delineate the underlying antibody evasion mechanism, we determined the escaping mutation profiles2, epitope distribution3 and Omicron neutralization efficacy of 1640 RBD-directed neutralizing antibodies (NAbs), including 614 isolated from BA.1 convalescents. Interestingly, post-vaccination BA.1 infection mainly recalls wildtype-induced humoral memory. The resulting elicited antibodies could neutralize both wildtype and BA.1 and are enriched on non-ACE2-competing epitopes. However, most of these cross-reactive NAbs are heavily escaped by L452Q, L452R and F486V. BA.1 infection can also induce new clones of BA.1-specific antibodies that potently neutralize BA.1; nevertheless, these NAbs are largely escaped by BA.2/BA.4/BA.5 due to D405N and F486V, and react weakly to pre-Omicron variants, exhibiting poor neutralization breadths. As for therapeutic NAbs, Bebtelovimab4 and Cilgavimab5 can effectively neutralize BA.2.12.1 and BA.4/BA.5, while the S371F, D405N and R408S mutations would undermine most broad sarbecovirus NAbs. Together, our results indicate that Omicron may evolve mutations to evade the humoral immunity elicited by BA.1 infection, suggesting that BA.1-derived vaccine boosters may not achieve broad-spectrum protection against new Omicron variants.

Comprehensive Epitope Mapping of Broad Sarbecovirus Neutralizing Antibodies

Omicron sub-lineage BA.2 has rapidly surged globally, accounting for over 60% of recent SARS-CoV-2 infections. Newly acquired RBD mutations and high transmission advantage over BA.1 urge the investigation of BA.2s immune evasion capability. Here, we show that BA.2 causes strong neutralization resistance, comparable to BA.1, in vaccinated individuals plasma. However, BA.2 displays more severe antibody evasion in BA.1 convalescents, and most prominently, in vaccinated SARS convalescents plasma, suggesting a substantial antigenicity difference between BA.2 and BA.1. To specify, we determined the escaping mutation profiles1,2 of 714 SARS-CoV-2 RBD neutralizing antibodies, including 241 broad sarbecovirus neutralizing antibodies isolated from SARS convalescents, and measured their neutralization efficacy against BA.1, BA.1.1, BA.2. Importantly, BA.2 specifically induces large-scale escape of BA.1/BA.1.1-effective broad sarbecovirus neutralizing antibodies via novel mutations T376A, D405N, and R408S. These sites were highly conserved across sarbecoviruses, suggesting that Omicron BA.2 arose from immune pressure selection instead of zoonotic spillover. Moreover, BA.2 reduces the efficacy of S309 (Sotrovimab)3,4 and broad sarbecovirus neutralizing antibodies targeting the similar epitope region, including BD55-5840. Structural comparisons of BD55-5840 in complexes with BA.1 and BA.2 spike suggest that BA.2 could hinder antibody binding through S371F-induced N343-glycan displacement. Intriguingly, the absence of G446S mutation in BA.2 enabled a proportion of 440-449 linear epitope targeting antibodies to retain neutralizing efficacy, including COV2-2130 (Cilgavimab)5. Together, we showed that BA.2 exhibits distinct antigenicity compared to BA.1 and provided a comprehensive profile of SARS-CoV-2 antibody escaping mutations. Our study offers critical insights into the humoral immune evading mechanism of current and future variants.

HPLC fingerprint studies and determination of six components in Phyllanthus urinaria L. collected from different habitats / 国际中医中药杂志

Objective:To establish a method of measuring the contents of gallic acid, brevifolin, corilagin, geraniin, ellagic acid and rutin in Phyllanthus urinaria L. simultaneously with fingerprint study for analysis. Methods:Phyllanthus urinaria L. was extracted by ultrasound with 50% methanol. Chromatographic separation was performed on a Phenonmenex Luna C18 (4.6 mm×250 mm, 5 μm). The mobile phase consisted of acetonitrile (A) and 0.1% phosphoric acid aqueous solution (B) with gradient elution. The flow rate was 1.0 ml/min. The column temperature was 25 ℃, and the injection volume was 10 μl. The detection wavelength was 270 nm. HPLC fingerprints of Phyllanthus urinaria L. from different habitats was established. PCA and OPLS-DA were used to analyze the differences in chemical components of different habitats. Results:Gallic acid, brevifolin, corilagin, geraniin, ellagic acid and rutin showed good linearity at 0.042 8-0.641 6, 0.033 4-0.501 4, 0.142 2-2.133 1, 0.383 1-5.746 5, 0.063 1-0.946 2 and 0.019 2-0.287 8 μg, respectively. The average recovery rate of them was 103.65%, 96.39%, 101.85%, 95.04%, 98.79% and 98.33%, respectively. The HPLC fingerprints of different habitats contained 14 characteristic common peaks, and six compounds characteristic peaks were identified. PCA analysis showed that the chemical components of Phyllanthus urinaria L. from different habitats were different. Geraniin, ellagic acid and corilagin were screened by OPLS-DA. Conclusions:The method is efficient, accurate and sensitive, which can be used to measure the six components in Phyllanthus urinaria L.. The established HPLC fingerprint of different habitats combined with the measrurement method of six components can be used for the quality control and evaluation of Phyllanthus urinaria L..

Detailed resume of RNA m6A demethylases

N6-Methyladenosine (m6A) is the most abundant internal modification in eukaryotic mRNA, playing critical role in various bioprocesses. Like other epigenetic modifications, m6A modification can be catalyzed by the methyltransferase complex and erased dynamically to maintain cells homeostasis. Up to now, only two m6A demethylases have been reported, fat mass and obesity-associated protein (FTO) and alkylation protein AlkB homolog 5 (ALKBH5), involving in a wide range of mRNA biological progress, including mRNA shearing, export, metabolism and stability. Furthermore, they participate in many significantly biological signaling pathway, and contribute to the progress and development of cancer along with other diseases. In this review, we focus on the studies about structure, inhibitors development and biological function of FTO and ALKBH5.

Correlation between the characteristics of motor evoked potential and severity of spinal cord injury in patients with acute cervical hyperextension injury and central spinal cord syndrome / 中华创伤骨科杂志

Objective:To study the correlation between the acute-phase characteristics of motor evoked potential (MEP) and severities of spinal cord injury in patients with acute cervical hyperextension injury and central cord syndrome (CCS).Methods:Retrospectively analyzed were the data of 45 patients with acute cervical hyperextension injury and CCS (observation group) who had been admitted to Department of Orthopedics, Tongji Hospital Affiliated to Tongji University from December 2018 to July 2021 and 20 healthy controls. Examination of transcranial magnetic stimulation-induced MEP was performed in patients with CCS and healthy controls using a magpro x100 magnetic stimulator, and recording was conducted in bilateral abductor pollicis brevis (APB). The characteristics of MEP waveform latency, amplitude and motor threshold were described and compared between the healthy control and observation groups; the correlations were analyzed between the MEP latency and the severity of spinal cord injury [American Spinal Injury Association (ASIA) total score and motor function of Upper Extremity Motor Subscores (UEMS)] in the observation group. According to different MEP-induced states, the patients in the observation group were divided into a resting group ( n=19), a facilitation group ( n=18), and a no-waveform group ( n=8). The severity of spinal cord injury (ASIA total score) and the functional independence of the spinal cord (SCIM-Ⅲ score) were compared among the 3 groups to analyze the correlation between the MEP-induced state and the severity of spinal cord injury (ASIA total score). Results:The observation group had a significantly longer MEP latency [(30.16±6.32) ms], a significantly smaller amplitude [(0.54±0.30) mV] and a significantly higher motor threshold [(65%±11%)] than the healthy control group (all P<0.05). The MEP latency in the observation group was significantly correlated with ASIA total score ( r=-0.730, P<0.001) and UEMS ( r=-0.740, P<0.001). The ASIA total score and SCIM-Ⅲ score were significantly different among the 3 groups ( P<0.05), and the MEP-induced state was significantly correlated with the severity of spinal cord injury (ASIA total score) ( r=0.668, P<0.001). Conclusions:In patients with acute cervical hyperextension injury and CCS, the MEP latency is prolonged, the amplitude lowered, and the motor threshold enhanced. The MEP latency is strongly correlated with the severity of spinal cord injury and upper limb motor function. The MEP-induced state is also closely related to the severity of spinal cord injury.

Expression of hsa_circ_0019413 in the peripheral blood of patients with primary Sj?gren's syndrome / 中华风湿病学杂志

Objective:To investigate the expression of hsa_circ_0019413 in the peripheral blood of patients with primary Sj?gren's syndrome (pSS) and its role in the development of pSS disease.Methods:Microarray screening of circ ribonucleic acid (circRNA) changes was first performed in the peripheral blood of 4 pSS patients and 4 healthy controls. Real-time quantitative reverse transcription polymerase chain reaction (qPCR) was used to verify the difference in the expression of hsa_circ_0019413 in the peripheral blood of 30 pSS patients and 30 controls. By establishing the receiver operating characteristic (ROC) curve, the potential diagnostic value of hsa_circ_0019413 in peripheral blood was analyzed, and the expression level of hsa_circ_0019413 was correlated with the clinical presentations of patients with pSS.Results:① By microarray analysis, 437 circRNAs were differentially expressed between the two groups (FC≥2.0, P<0.05), of which 365 were up-regulated and 72 were down-regulated. ② The expression level of hsa_circ_0019413 in pSS patients was significantly higher than that in healthy controls by qPCR. The difference between the two groups was statistically significant ( P<0.05). It showed that hsa_circ_0019413 in peripheral blood of pSS patients had potential diagnostic value by ROC curve analysis [area under the curve (AUC)=0.883, 95% CI (0.782, 0.984), P<0.01]. ③ The expression level of hsa_circ_0019413 was positively correlated with the ESSDAI, ANA, titer of the pSS patients by correlation analysis ( r=0.721, P=0.012; r=0.625, P=0.040), but not with (immunoglobulin (Ig)G or erythrocyte sedimentation rate (ESR). Conclusion:Hsa_circ_0019413 in the peripheral blood may be involved in the development of pSS and may be a biomarker for the diagnosis of pSS.

Application of endoscopic resection of benign tumor in infratemporal fossa / 中华耳鼻咽喉头颈外科杂志

Objective@#To explore the application of endoscopy and clinical effect of endoscopic resection of benign tumor in infratemporal fossa.@*Methods@#The clinical data of 11 patients with benign tumors in infratemporal fossa admitted to the Department of Otorhinolaryngology Head and Neck Surgery and Skull Base Surgery of the Affiliated Hospital of Qingdao University from January 2016 to September 2018 were retrospectively analyzed. There were 6 males and 5 females, with the age ranging from 11 to 63 years old. The main clinical manifestations were pharyngeal foreign body sensation, submaxillary pain, maxillofacial numbness and tongue numbness. Imaging examination showed that the tumor was round and had a clear boundary with the surrounding tissue. All the patients underwent endoscopic surgery. Appropriate surgical approach was selected according to the location of the tumor and its relationship with the internal carotid artery. The endoscopic surgical approaches included trans-oropharyngeal approach in 7 cases, trans-lateral pterygomandibular raphe approach in 1 case and trans-medial pterygomandibular raphe approach in 3 cases. The pathological results, prognosis, complications and relapse of patients were summarized through descriptive statistics.@*Results@#The tumors were completely resected under endoscope in all patients, and there was no significant complication occurred after surgery. The average pain VAS score was 3.1 after surgery and average hospital stay was 5.9 d. The postoperative pathological diagnoses consisted of 6 cases of pleomorphic adenoma, 4 cases of neurilemmoma and 1 case of basal cell adenoma. All patients were followed up regularly from 6 to 39 months without recurrence of tumor.@*Conclusion@#Endoscopic resection of benign tumors in infratemporal fossa has the advantages of minimal damage, rapid recovery, few complications, and definite curative effect, which can be used as an important alternative for surgical treatment of benign tumors.

Analysis of clinical features of respiratory epithelial adenomatoid hamartoma in the nasal cavity / 中华耳鼻咽喉头颈外科杂志

Objective@#To analyze the clinical features of respiratory epithelial adenomatoid hamartoma (REAH) in the nasal cavity.@*Methods@#Clinical datas of 23 patients, who were hospitalized in Department of Otorhinolaryngology Head and Neck Surgery, the Affiliated Hospital of Qingdao University, from February 2016 to February 2018 with histopathologically proved REAH in the nasal cavity were reviewed. There were 18 males and 5 females, with the age range from 16 to 71 years old. The most common area, main symptoms, surgical methods and follow-up results were analyzed.@*Results@#The most common area was olfactory cleft (21 cases), and the mainly symptom was nasal congestion (18 cases). All the patients received transnasal endoscopic surgery and had no recurrence during following-up from three months to one year.@*Conclusions@#The most common area of REAH in the nasal cavity is the olfactory cleft. Histopathological result is needed to make a definite diagnosis. Complete surgical resection is the main treatment.

Analysis of a girl with Phelan-McDermid syndrome / 中华医学遗传学杂志

OBJECTIVE@#To explore the value of single nucleotide polymorphism (SNP) array for molecular diagnosis.@*METHODS@#A Chinese girl suspected for Phelan-McDermid syndrome was subjected to routine G-banding chromosomal analysis, SNP array, and fluorescence in situ hybridization (FISH) assaying.@*RESULTS@#G-banding karyotype analysis has found no abnormality in the girl and her parents. SNP array detected a heterozygous 2.1 Mb deletion at 22q13.33 in the girl, which was confirmed by FISH. The same deletion was not found in either parent. FISH analysis found that her father has carried a balance t(4;22) translocation.@*CONCLUSION@#SNP-array has the advantage of high resolution and accuracy, which is valuable for the diagnosis of microdeletion or microduplication syndromes.

Diagnosis of a fetus with partial 17p trisomy using chromosomal microarray analysis / 中华医学遗传学杂志

OBJECTIVE@#To use single nucleotide polymorphism microarray (SNP array) to screen whole genome copy number variations (CNVs) in a fetus with multiple malformation.@*METHODS@#Amniotic fluid sample was subjected to routine G banding chromosomal analysis and CNVs detection, and its parents were tested in order to determine the origin of fetal chromosomal aberration.@*RESULTS@#SNP array has detected a large fragment repetition spanning approximately 16 Mb in the 17q24.2-q25.3 region in the fetus. The karyotype of amniotic fluid was 46,XY,der(21),t(17;21)(q23;p12). The karyotype of the mother was normal, while its father has a karyotype of 46,XY,t(17;21)(q23;p12).@*CONCLUSION@#The large repetition at 17q24.2-q25.3 probably underlies the multiple fetal malformation. Abnormal fetuses carrying apparently balanced chromosomal translocations may harbor CNVs outside the breakpoint regions involved in the rearrangements. SNP array has provided a useful supplement for the conventional G banding karyotyping analysis.

Impact of in vitro fertilization-embryo transfer on adverse pregnancy outcomes: A prospective cohort study / 中南大学学报(医学版)

To evaluate whether the in vitro fertilization-embryo transfer (IVF-ET) procedures could increases the risks of adverse pregnancy outcomes (APOs) in offspring.
 Methods: A hospital-based prospective cohort design was conducted, which contained a control group of singleton pregnancies with indicators of subfertility who were still conceived naturally after using simple medical treatment (e.g. minimal medical intervention or ovulation induction), and an exposure group consisted of singleton pregnancies who had a history of infertility and IVF-ET treatment. All factors different between two groups in the univariate analysis were included in the multivariable logistic regression to evaluate the independent effect of IVF-ET procedures themselves on APOs.
 Results: After controlling for confounding factors by using multivariate logistic regression analysis, our results showed that pregnancies after IVF-ET experienced a higher risk of preterm birth (OR=1.28, 95% CI 1.05 to 1.56), low birth weight (OR=1.69, 95% CI 1.27 to 2.31), perinatal mortality (OR=5.33, 95% CI 2.44 to 11.81), and congenital malformations (OR=1.83, 95% CI 1.12 to 2.94).
 Conclusion: The IVF-ET operational factors may increase the risk of APOs.

Study on the effect of oxidative stress on the cardiac injury induced by MEHP in rats / 中华劳动卫生职业病杂志

Objective@#This study was to investigate the effects of MEHP on isolated rat heart and explore its mechanism.@*Methods@#The experiments were performed with Langendorff-perfused rat heart with a Langendorff apparatus. 35 SD rats were used in the experiment and there were 5 rats per group. MEHP at doses of 3.125, 6.250, 12.500 and 25.000 μmol/L were given to the hearts for 25 minutes. Effects of NAC at concentration of 5 mmol/L were evaluated by co-treatment with 12.500 or 25.000 μmol/L MEHP. Data was collected per 5 minutes for 25 minutes. The heart rate, LVDP, LVEDP, dp/dtmax, and dp/dtmin were measured and analyzed using a PL3508 Data Acquisition and Analysis System. 200 waves at least were required each time. LDH contents in heart lavage fluid were determined by photometric assays using the automated biochemical analyzer. A section of the heart tissue was used for histopathological examination. DCFH-DA method was used to detect the levels of reactive oxygen species in different groups of heart tissues.@*Results@#There was a concentration dependent decrease of heart rate (P<0.05) . At concentrations of 6.250, 12.500 and 25.000 μmol/L, MEHP significantly decreased the LVDP, dp/dtmax and dp/dtmin (P<0.05) , and this decrease is more pronounced with perfusion time. As the MEHP was given up to 6.250, 12.500 and 25.000 μmol/L, a statistical significance was found in the increase of LVEDP (P<0.05) . For dp/dtmin, a significant increase was observed at the concentration of 3.125 μmol/L when perfused with 10 and 15 min (P<0.05) , but this increase disappeared over time. LDH in cardiac perfusate increased as the MEHP given a higher concentration (P<0.05) . Compared with the control group, Histopathological analysis showed edema of myocardial tissue and cells, and inflammatory cells infiltration and myocardial cells necrosis were obvious in the MEHP perfusion groups. Myocardial ROS levels of the four MEHP treatment groups were all significantly higher than that of control group (P<0.05) . These heart damage induced by MEHP could be attenuated by NAC in different degrees.@*Conclusion@#MEHP can induce damage to myocardial tissue of isolated rat heart and one possible mechanism is the oxidative stress

Comparison of the effects of propylthiouracil and methimazole in the treatment of hyperthyroidism / 中国基层医药

Objective To compare the effects of propylthiouracil and methimazole in the treatment of hyperthyroidism.Methods From January 2014 to January 2015,100 patients with hyperthyroidism in Tengnan Hospital of Zaozhuang Mining Group were selected as study objects,and they were divided into control group and research group according to the digital table,with 50 cases in each group.The control group was treated with propylthiouracil,the research group was treated with methimazole.The clinical effects,thyroid associated antibody level,other relevant indicators and adverse reactions between two groups were compared.Results The total effective rate of the research group was higher than that of the control group(84％ vs.80％),the difference was not statistically significant (x2 =0.271,P ＞ 0.05).Before treatment,the thyrotropin receptor antibody(TRAb) and anti-thyroid peroxidase antibody (TPOAb) between the two groups had no statistically significant differences(t =0.141,0.199,all P ＞ 0.05).After treatment,TRAb of the research group was lower than that of the control group [(7.84 ± 4.26) U/L vs.(8.67 ±4.48) U/L],TPOAb of the research group was higher than that of the control group[(167.62 ± 45.53) IU/mL vs.(158.37 ± 49.40) IU/mL],but the differences were not statistically significant (t =0.949,0.974,all p ＞ 0.05).After treatment,FT3 [(7.34 ± 2.36) pmol/L vs.(13.78 ± 2.91) pmoL/L] and FT4 [(18.52 ± 6.79) pmol/L vs.(23.71 ±6.52) pmol/L] of the research group were lower than those of the control group,the differences were significantly significant (t =12.154,3.899,all P ＜0.05).In the 2 years follow-up,24 cases(48％) in the research group stopped taking medicine,and 14 cases(28％) in the control group,the rate between the two groups had statistically significant difference (x2 =4.244,P ＜ 0.05).The thyroid-stimulating hormone (TSH) recovery time,symptom control time,liver injury time of the research group were (7.45 ± 4.01) months,(6.86 ± 3.49) weeks,(20.85 ± 8.34) d,respectively,which were shorter than those of the control group [(10.36 ± 5.14) months,(9.75 ± 3.42)weeks,(39.21 ± 27.65) d],the differences were statistically significant(t =4.i82,3.156,4.495,all P ＜ 0.05).The incidence rate of liver injury and total incidence rate of adverse reaction of the research group were 8％,54％,which were significantly lower than those of the control group (22％,74％) (x2 =3.843,4.340,all P ＜ 0.05).Conclusion Both propylthiouracil and methimazole have good treatment effects in hyerthyroidism,but methimazole works rapidly,and with good safety.

Treatment options and prognosis of infection after total knee arthroplasty / 中华骨科杂志

Objective To investigate surgical interventions for periprosthetic joint infection (PJI) after total knee arthroplasty and characteristics of prognosis.Methods Sixty-two patients with PJI after total knee arthroplasty from January 2000 to November 2016 were reviewed retrospectively,included with 17 males and 45 females.The mean age was 66.0± 10.2 years old (37-85).Fourty-nine patients were diagnosed with osteoarthritis,9 with rheumatoid arthritis,2 with secondary ankyloses after suppurative arthritis and 2 with hemophilia arthritis.Forty-one patients underwent unilateral total knee arthroplasties,and 21 bilateral total knee arthroplasties.Characteristics of PJI,including infection types,existence of sinus tract,infectious pathogen,surgical intervention and patients' prognosis,were collected.Results Twenty-four patients underwent open debridement with prothesis retention.In the 14 successful cases,medial time interval between primary total knee arthroplasty and debridement was 33 days.One case of positive Methicillin resistant Staphylococcus aureus culture of joint aspiration,and 1 case formed sinus tract.In 10 cases of failed debridement,the medial time interval was 270 d.Intra-articular culture presented 4 cases of antibiotic resistant bacteria,and 6 cases formed sinus tract.Except for one patient gave up treatment and another received arthrodesis,the other 8 failed cases were all treated with revisions.In 46 revisions,nine patients underwent one-stage revisions.The mean time interval between primary total knee arthroplasty and revision was 15.9± 14.5 d.Intra-articular culture presented 3 cases of antibiotic resistant bacteria,and 1 case formed sinus tract.In the other 37 two-stage revisions,the mean time interval was 1 045.7±1 044.1 d.Intra-articular culture showed 15 cases of antibiotic resistant bacteria,and 12 cases formed sinus tract.The mean follow-up duration was 73.9±48.2 months.At the last follow-up,all patients were free of antibiotics treatment.The mean Knee Society Score (KSS) was 85.9±4.3 after successful open debridement with prothesis retention.The KSS of one-stage revision patients was 78.5±3.3,while that of two stage revision patients was 65.7±7.4.Statistical difference was found among groups (P＜0.05).Conclusion For PJI within 3 weeks after total knee arthroplasty without sinus tract or intra-articular culture of antibiotic resistant bacteria,open debridement with prosthesis retention could be recommended.One stage revision could be applied in infectious cases which appeared between 3 weeks to 1 month after primary surgery or in cases with unstable prostheses found in open debridement.For infectious cases longer than 1 month after primary procedure or those with sinus tract,severe soft tissue deficiency,intra-articular culture of antibiotic resistant bacteria,two-stage revision could be recommended.

Osteogenic Factor Runx2 Marks a Subset of Leptin Receptor-Positive Cells that Sit Atop the Bone Marrow Stromal Cell Hierarchy.

Bone marrow mesenchymal stem and progenitor cells (BM-MSPCs) maintain homeostasis of bone tissue by providing osteoblasts. Although several markers have been identified for labeling of MSPCs, these labeled cells still contain non-BM-MSPC populations. Studies have suggested that MSPCs are observed as leptin receptor (LepR)-positive cells, whereas osteoblasts can be classified as positive for Runx2, a master regulator for osteoblastogenesis. Here, we demonstrate, using Runx2-GFP reporter mice, that the LepR-labeled population contains Runx2-GFPlow sub-population, which possesses higher fibroblastic colony-forming units (CFUs) and mesensphere capacity, criteria for assessing stem cell activity, than the Runx2-GFP- population. In response to parathyroid hormone (PTH), a bone anabolic hormone, LepR+Runx2-GFPlow cells increase Runx2 expression and form multilayered structures near the bone surface. Subsequently, the multilayered cells express Osterix and Type I collagen α, resulting in generation of mature osteoblasts. Therefore, our results indicate that Runx2 is weakly expressed in the LepR+ population without osteoblastic commitment, and the LepR+Runx2-GFPlow stromal cells sit atop the BM stromal hierarchy.

Identification of a novel SLC26A4 mutation in a child with enlarge vestibular aqueduct syndrome / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To analyze mutations of SLC26A4 gene and explore their origins for a patient with enlarge vestibuar aqueduct syndrome.</p><p><b>METHODS</b>Clinical data and peripheral venous blood samples were collected from the patient and her parents. Genome DNA was extracted from the peripheral blood. All of the 21 exons of the SLC26A4 gene were amplified with PCR and subjected to directly sequencing.</p><p><b>RESULTS</b>The patient was found to have carried two mutant alleles of the SLC26A4 gene, namely c.1522A to G and c.1229C to T, which were inherited from her father and mother, respectively.</p><p><b>CONCLUSION</b>SLC26A4 c.1522A to G is likely to be a pathogenic mutation. Above results may facilitate genetic counseling and prenatal diagnosis for this family.</p>

Screening of mutations of deafness-related genes in women of child-bearing age from Shijiazhuang area / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To screen for mutations of deafness-related genes among ethic Chinese women of child-bearing age.</p><p><b>METHODS</b>In 324 women, 9 mutational sites in 4 deafness-related genes (SLC26A4, GJB3, GJB2 and mtDNA 12s rRNA) were screened using a gene chip.</p><p><b>RESULTS</b>Twenty women (6.17%) have carried mutations. These included 11 (3.40%) carrying a GJB2 gene mutation, 7 (2.16%) carrying a SLC26A4 gene mutation, 1 (0.31%) simultaneously carrying GJB3 and GJB2 gene mutations, and 1 (0.31%) carrying a mtDNA 12s rRNA gene mutation.</p><p><b>CONCLUSION</b>Women of child-bearing age have a high rate for carrying mutations of common deafness-related genes, among which 235delC in GJB2 was most common. Prenatal screening of couples with normal hearing is an effective way to prevent birth of affected children.</p>