Clinical outcomes of proximal femoral reconstruction technique combined with THA in the treatment of high dislocation secondary to septic arthritis: a retrospective single-center study.

PURPOSE: The aim of this retrospective study was to examine the clinical outcomes and complications of proximal femur reconstruction (PFR) combined with total hip arthroplasty (THA) in patients with high hip dislocation secondary to septic arthritis (SA). METHODS: Between September 2016 to September 2021, we performed a series of 15 consecutive PFR combined with THA on patients with high dislocation of the hip secondary to SA, of these,12 hips were reviewed retrospectively, with a mean follow-up of 2.5 years (range, 1.5-6 years). The mean age of the patients at the time of surgery was 52 years (range, 40-70 years). RESULTS: All patients were followed up. At 1-year postoperative follow-up, the median HHS increased from 32.50 preoperatively to 79.50 postoperatively. The median VAS decreased from 7 before surgery to 2 at 1 year after surgery. The median LLD reduced from 45 mm preoperatively to 8 mm at 1 year after surgery. The mean operative time 125 ± 15 min (range 103-195 min). Mean estimated blood loss was500 ± 105ml (range 450-870 ml). Mean hospital days 9.5 days (range 6-15 days). Two patients developed nerve injuries that improved after nutritional nerve treatment. One patient had recurrent postoperative dislocation and underwent reoperation, with no recurrence dislocation during the follow-up. There were no cases of prosthesis loosening during the follow-up period. One patient developed acute postoperative periprosthetic joint infection (PJI) that was treated with Debridement, Antibiotics and Implant Retention (DAIR) plus anti-infective therapy, with no recurrence during 2 years of follow-up. CONCLUSION: This study indicates PFR combined with THA shows promise as a technique to manage high hip dislocation secondary to SA, improving early outcomes related to pain, function, and limb length discrepancy.

Comparison of culture and broad-range polymerase chain reaction methods for diagnosing periprosthetic joint infection: analysis of joint fluid, periprosthetic tissue, and sonicated fluid.

PURPOSE: This study compared the diagnostic capabilities of culture and broad-range polymerase chain reaction (PCR) using joint fluid (JF), periprosthetic tissue (PT), and sonicated fluid (SF) for the diagnosis of periprosthetic joint infection (PJI). METHODS: Sixty-seven subjects underwent knee or hip revision surgery, with 53 PJI and 14 aseptic failure (AF) cases included retrospectively. JF, PT, and SF samples were collected after a suspension of antibiotics more than two weeks, and culture and broad-range PCR were performed for all samples. RESULTS: The sensitivities of SF culture (83.0%), JF-PCR (83.0%), and SF-PCR (84.9%) were similar (P > 0.05), but each was significantly more sensitive than JF culture (69.8%), PT culture (71.7%), and PT-PCR (34.0%) (P < 0.05). The specificities of JF culture, PT culture, SF culture, JF-PCR, PT-PCR, and SF-PCR were similar (100, 100, 85.7, 85.7, 100, and 78.6%, respectively) (P > 0.05). PCR was unable to accurately detect six polymicrobial infections and two fungal infections. CONCLUSIONS: SF culture, JF-PCR, and SF-PCR were more sensitive than JF culture, PT culture, and PT-PCR for diagnosing PJI among patients who have stopped taking antibiotics for two weeks or more. Compared with PCR methods, SF culture has the advantage of detecting polymicrobial or fungal infections. PT-PCR proved to be insufficiently sensitive for providing correct diagnoses.

Elevated B Cell Activation is Associated with Type 2 Diabetes Development in Obese Subjects.

BACKGROUND/AIMS: Despite strong association between obesity and the pathogenesis of type 2 diabetes (T2D), only a subset of obese individuals eventually develops T2D. We sought to determine the immunological factors behind this heterogeneity. METHODS: Peripheral blood of obese non-diabetic subjects and obese diabetic subjects were collected and the B cell responses in these subjects were analyzed. RESULTS: We found that the B cells from obese diabetic subjects had similar B cell subtype composition and secreted similar levels of low-grade pro-inflammatory cytokines to obese non-diabetic subjects, characteristic to the background chronic immune activation frequently observed in obese subjects. When examining adaptive B cell antibody responses, however, obese diabetic subjects presented much higher levels of polyclonal activation and antibody secretion, with impaired ability to response to new antigens such as seasonal influenza vaccination. CONCLUSIONS: These data demonstrated that in obese diabetic subjects, B cell adaptive response is impaired and potentially contribute to overall higher inflammation.

Association between MTHFR C677T polymorphism and cognitive impairment in patients with cerebral small vessel disease: a cross-sectional study.

Objective: Cerebral small vessel disease (CSVD) is the most common vascular cause of cognitive impairment. This study aimed to explore the association between MTHFR C677T polymorphism and cognitive impairment in CSVD patients. Methods: Demographic, medical, laboratory, cognitive evaluation, and MTHFR C677T polymorphism data were collected from CSVD patients admitted to our hospital between January 2019 and July 2023. Inclusion criteria for CSVD were based on the Standards for Reporting Vascular changes on Neuroimaging (STRIVE) criteria, with age ≥ 45 years. Binary logistic regression models were used to analyze risk factors associated with WMH and cognitive impairment. Results: A total of 330 CSVD participants were recruited in this study, including 179 male and 151 female, with a median age of 64 years (interquartile range: 58-73 years). There were 185 patients (56.1%) with cognitive impairment, 236 patients (71.5%) with WMH, 89 patients (27.0%) with CMB, 87 patients (26.4%) with lacunes. All participants completed MTHFR polymorphism analysis, 149 cases (45.2%) of the CC genotype, 112 cases (33.9%) of the CT genotype and 69 cases (20.9%) of the TT genotype. Patients with TT genotype exhibited higher plasma homocysteine levels and more severe WMH and cognitive impairment (p < 0.001). Multivariable binary logistic regression model showed that WMH was significantly associated with age (p = 0.019), history of hypertension (p = 0.011), HHcy (p = 0.019) and MTHFR genotype (p = 0.041); while cognitive impairment was significantly associated with age (p = 0.033), history of hypertension (p = 0.019), HHcy (p = 0.040), MTHFR genotype (p = 0.039), WMH (p = 0.041), and lacunes (p = 0.001). Conclusion: In this cross-sectional study, we investigated the association between MTHFR C677T polymorphism and cognitive function in CSVD patients. We found that MTHFR 677 TT genotype was an independent risk factor for the progression of WMH and cognitive impairment in CSVD patients.

Improved cure rate of periprosthetic joint infection through targeted antibiotic therapy based on integrated pathogen diagnosis strategy.

Objectives: This study aimed to determine whether combined of pathogen detection strategies, including specimen acquisition, culture conditions, and molecular diagnostics, can improve treatment outcomes in patients with periprosthetic joint infections (PJI). Methods: This retrospective study included suspected PJI cases from three sequential stages at our institution: Stage A (July 2012 to June 2015), Stage B (July 2015 to June 2018), and Stage C (July 2018 to June 2021). Cases were categorized into PJI and aseptic failure (AF) groups based on European Bone and Joint Infection Society (EBJIS) criteria. Utilization of pathogen diagnostic strategies, pathogen detection rates, targeted antibiotic prescription rates, and treatment outcomes were analyzed and compared across the three stages. Results: A total of 165 PJI cases and 38 AF cases were included in this study. With the progressive implementation of the three optimization approaches across stages A, B and C, pathogen detection rates exhibited a gradual increase (χ2 = 8.282, P=0.016). Similarly, utilization of targeted antibiotic therapy increased stepwise from 57.1% in Stage A, to 82.3% in Stage B, and to 84% in Stage C (χ2 = 9.515, P=0.009). The 2-year infection control rate exceeded 90% in both stages B and C, surpassing stage A (71.4%) (χ2 = 8.317, P=0.011). Combined application of all three optimized protocols yielded the highest sensitivity of 91.21% for pathogen detection, while retaining higher specificity of 92.11%. Conclusion: The utilization of combined pathogen diagnostic strategies in PJI can increase pathogen detection rates, improve targeted antibiotic prescription, reduce the occurrence of antibiotic complications, and achieve better treatment outcomes.

Wireless Optogenetic Targeting Nociceptors Helps Host Cells Win the Competitive Colonization in Implant-Associated Infections.

The role of nociceptive nerves in modulating immune responses to harmful stimuli via pain or itch induction remains controversial. Compared to conventional surgery, various implant surgeries are more prone to infections even with low bacterial loads. In this study, an optogenetic technique is introduced for selectively activating peripheral nociceptive nerves using a fully implantable, wirelessly rechargeable optogenetic device. By targeting nociceptors in the limbs of awake, freely moving mice, it is found that activation induces anticipatory immunity in the innervated territory and enhances the adhesion of various host cells to the implant surface. This effect mediates acute immune cell-mediated killing of Staphylococcus aureus on implants and enables the host to win "implant surface competition" against Staphylococcus aureus. This finding provides new strategies for preventing and treating implant-associated infections.

[Effect of compound Danshen Dripping Pill on carotid arterial intima-media in patients with type 2 diabetes mellitus].

OBJECTIVE: To investigate the effect of compound Danshen Dripping Pill (DSP) on carotid arterial intima-media thickness (IMT) in patients with type 2 diabetes mellitus (T2DM). METHODS: One hundred and thirty T2DM patients were assigned to four groups, 32 in the Group A, the control group treated with blood glucose (BG) and blood pressure (BP) controlling; 32 in the Group B, with BG, BP and blood lipid (BL) controlling, 32 in Group C with BG, BP, BL controlling and vitamin E administration, and 34 in Group D with BG, BP, BL controlling and DSP administration. Patients in Group D were subdivided by Chinese medicine syndrome differentiation into four types, 8 of Yin-deficiency with flourishing heat type (YDFH), 5 of both qi-yin deficient type (BQYD), 8 of both yin-yang deficient type (BYYD) and 13 of blood-stasis and qi-stagnant type (BSQS). Fasting blood glucose (FBG), BP and BL in patients were observed periodically, and IMT in them were measured by ultrasonography before treatment, as well as at the end of the 1st, 3rd, and 5th year of treatment to dynamically observe the changes of IMT and condition of plaque formation, and analyze the relation between them with FBG, BP and BL. RESULTS: The 5-year follow-up was performed in 105 patients. In the observation period, level of total cholesterol (TC) showed a decreasing trend and level of high density cholesterol (HDL-C) showed an increasing trend in all the 4 groups, the improvements in Group C and D were slightly better than those in Group B, while significantly superior to those in Group A; the changes of FBG and glycosylated hemoglobin (HbAlc) were insignificant in the 4 groups. IMT and numbers of atheroma plaque increased gradually in all groups in the observation period, however, the changes in Group D were lesser than those in other groups, showing significant difference (P < 0.01). It was showed that the increasing of cervical carotid IMT in T2DM patients was correlated with levels of HbAlc, HDL-C, LDL-C, triglyceride and TC, especially in Group D. CONCLUSION: DSP might delay the occurrence and development of diabetic macro-vascular disease.

Autoantibody-positivity in lean type II diabetes patients was associated with elevated Th17-like CD4+CXCR5+ T cell responses.

The pathophysiology of type II diabetes (T2D) in patients with normal body-mass index (BMI) remains unclear. In this study, we investigated the circulating CD4+CXCR5+ T cells in lean T2D patients. Compared with age-, gender-, and BMI-matched healthy controls, the lean T2D patients presented similar frequency and number of CD4+CXCR5+ T cells; however, the composition of CD4+CXCR5+ T subsets was altered. The CD4+CXCR5+ T cells in lean T2D patients were enriched with a Th17-like subset, characterized by an increase in the frequency of IL-17-secreting cells, and an increase in the frequency of CCR6+ cells. Compared to CCR6- CD4+CXCR5+ T cells, CCR6+ CD4+CXCR5+ T cells secreted significantly higher IL-17. Neither the frequency of IL-17-secreting CD4+CXCR5+ T cells, nor the frequency of CCR6+ CD4+CXCR5+ T cells, was associated with the BMI of the T2D patients. Interestingly, 10 out of 30 lean T2D patients in our cohort presented islet-reactive autoantibodies. Compared to the autoantibody-negative T2D patients, the autoantibody-positive T2D patients had significantly higher levels of IL-17-secreting CD4+CXCR5+ T cells and CCR6+ CD4+CXCR5+ T cells. In addition, compared to the CCR6- CD4+CXCR5+ T cells, the CCR6+ CD4+CXCR5+ T cells were more effective at promoting Ig secretion from autologous B cells. Together, this study demonstrated that an upregulation of Th17-like CD4+CXCR5+ T cells was present in lean T2D patients and was associated with autoantibody positivity.

Metagenomic next-generation sequencing contribution in identifying prosthetic joint infection due to Parvimonas micra: a case report.

Identifying fastidious pathogens in patients with prosthetic joint infection (PJI) by culture is challenging. Metagenomic next-generation sequencing (mNGS) is a novel culture-independent approach that is associated with a higher likelihood for identifying pathogens. We present a case where mNGS was implemented to identify Parvimonas micra, a rarely reported and difficult-to-culture PJI pathogen.

Diagnosis of osteoarticular tuberculosis via metagenomic next-generation sequencing: A case report.

Osteoarticular tuberculosis (OAT) may cause severe complications and disability. Due to its indolent nature, OAT is difficult to diagnose in the early stages. Diagnosis by conventional culture is time-consuming and insensitive, and polymerase chain reaction-based molecular diagnostic methods are incapable of excluding co-infections. Metagenomic next-generation sequencing (mNGS) may identify a broad spectrum of microorganisms, including Mycobacterium, bacteria and fungi, in clinical specimens. Therefore, the diagnosis of OAT may be rapidly performed using mNGS. The present study reports on a case of OAT. The patient presented with right knee swelling and pain for 1 year; his C-reactive protein levels and erythrocyte sedimentation rate were markedly elevated. Although multiple pre-operative cultures were negative, mNGS was finally used to successfully detect the underlying pathogen. The result was confirmed by other molecular biology methods and Mycobacterium culture. Anti-tuberculosis therapy was administered accordingly and the patient finally recovered. In conclusion mNGS, with the ability to detect Mycobacterium and other microorganisms in a single assay, is an emerging approach for rapidly and accurately diagnosing OAT. This method may provide significant support to guide physicians in selecting the appropriate pharmacotherapy and surgical treatments.

Osteoporosis in postmenopausal women in this decade: a bibliometric assessment of current research and future hotspots.

Postmenopausal osteoporosis (PMOP) has already become a major public health problem. However, there was no bibliometric analysis estimating the evolutionary process of PMOP research. PURPOSE: This study aimed to assess its scientific activity. METHODS: Publications on PMOP were retrieved from Science Citation Index-Expanded (SCI-E) of the Web of Science (WoS) from 2008 to 2018. VOSviewer software was used for data mining and visualization. The quantity of papers, number of citations, citation frequency per year, and H-index were assessed and compared among different countries, institutes, and researchers. RESULTS: A total of 11,142 papers were included and were cited 184,416 times. The USA contributed the most papers (3162), the most citations (83,270 times), and the highest H-index (115). Canada ranked first for the number of papers per million populations and per trillion GDP. Seven of the top ten funding agencies were industries. The key words were stratified into four clusters: cluster 1 ("basic research"), cluster 2 ("diagnosis"), cluster 3 ("treatment"), and cluster 4 ("others"). Average appearing years (AAY) of key words in cluster 1 were the largest compared to those in clusters 2 and 3. For hotspots, "miRNA" showed a relatively latest AAY of 2017.63, followed by "abaloparatide" and "adipokine". CONCLUSION: We concluded that the USA and Europe were the most productive regions on PMOP, with a high prevalence of articles supported by pharmaceutical companies. Key word focus gradually shifted from "diagnosis" to "treatment" and then to precision medicine orientated "basic research". It is recommended to pay attention to potential research hotspots, such as "miRNA," "abaloparatide," and "adipokine".

Bibliometric analysis of global scientific activity on umbilical cord mesenchymal stem cells: a swiftly expanding and shifting focus.

Several studies have focused on umbilical cord-derived mesenchymal stem cells (UC-MSCs) due to their potential therapeutic effects in a cluster of diseases. However, there has been no bibliometric analysis evaluating the evolution in UC-MSC research. Therefore, this study aimed to assess scientific activity regarding UC-MSC research. Publications on UC-MSCs were retrieved from the Science Citation Index-Expanded (SCI-E) of the Web of Science (WoS) from 1975 to 2017. Statistical analyses were performed using Excel, GraphPad Prism 5, and VOSviewer software. Comparative analyses were employed to assess contributions between different countries, institutes, and researchers. With 21.26 citations per paper, 1206 papers cited 25,517 times were included. Mainland China contributed the most with 558 papers, with the most citations (6858 times) and the highest H-index (43). South Korea ranked first for number of papers per million people and per trillion gross domestic product (GDP). Keywords were stratified into two clusters by VOSviewer software: cluster 1, "treatments and effects"; and cluster 2, "characteristics". The average appearing years (AAY) of keywords in cluster 1 was more recent than that in cluster 2. For promising hotspots, "TNF-α" showed the latest AAY at 2014.09, followed by "migration", "angiogenesis", and "apoptosis". We conclude that the number of publications has been continuously growing dramatically since 2002 and that mainland China and South Korea are the most productive regions. The focus gradually shifts from "characteristics" to "treatments and effects". Attention should be drawn to the latest hotspots, such as "TNF-α", "migration", "angiogenesis", and "apoptosis". Furthermore, funding agencies might increase investments in exploring the therapeutic potential of UC-MSCs.

Non-obese type 2 diabetes patients present intestinal B cell dysregulations associated with hyperactive intestinal Tfh cells.

Most current studies of type 2 diabetes (T2D) focus on obesity in the pathogenesis of the disease. However, many individuals develop T2D at non-obese body mass index (BMI) level. It is yet unclear whether certain etiological mechanisms discovered in these obese models can apply to non-obese T2D patients. In the present study, we focused on one aspect that was potentially involved in T2D development, the intestinal inflammation, and examined the difference between non-obese T2D patients and BMI-matched healthy controls. We found that non-obese T2D patients presented significantly higher levels of fecal IgG than BMI-matched controls. Compared to active Crohn's disease patients, both T2D and healthy controls presented lower levels of fecal IgG. In the mucosal biopsies, the B cells and plasmablasts from T2D patients presented a slight but significant increase in the frequencies of cells with surface IgG expression compared to those from healthy individuals. The potential mechanism resulting in increased IgG expression was then examined. The CD4+CXCR5+ T cells (Tfh) from non-obese T2D patients were highly enriched in IFN-γ-producing cells and depleted in IL-4- and IL-17-producing cells. Presence of mucosal CD4+CXCR5+ T cells significantly increased IgG production from mucosal samples. Interestingly, when stimulated with E. coli, a common intestinal microbe, the CD4+CXCR5+ T cells from T2D patients presented significantly higher IFN-γ expression than CD4+CXCR5+ T cells from BMI-matched controls Together, these results demonstrated that non-obese T2D patients presented a low-grade inflammation in the intestinal tract, possibly supported by bacteria-responding CD4+CXCR5+ T cells.

Bibliometric Analysis of Global Scientific Research on lncRNA: A Swiftly Expanding Trend.

To investigate trends in long-noncoding (lnc) RNA research systematically, we compared the contribution of publications among different regions, institutions, and authors. Publications on lncRNA were retrieved from Web of Science (WoS) from 1975 to 2017. A total of 3879 papers were identified, and together they were cited 62967 times. The literature on lncRNA had been continuously growing since 2006, and the expansion might continue at a rapid pace until around 2021. China contributed the greatest proportion (63.47%) of lncRNA publications, and the USA ranked second in the number of publications (944 articles), while it had the highest citation frequency (43168 times) and H-index (97). The journal Oncotarget has the greatest number of publications on lncRNA research, with 305 papers. The keywords could be stratified into two clusters: cluster 1 (application) and cluster 2 (characteristics). Correspondingly, the "TNM stage," "epithelial mesenchymal transition (EMT)," "cell apoptosis," and "overall survival" are research hotspots since 2015. Thus, research on lncRNA showed a swiftly expanding trend, with China making the largest contribution. The focus on lncRNA is gradually shifting from "characteristics" to "application."

SIRT4 overexpression protects against diabetic nephropathy by inhibiting podocyte apoptosis.

Diabetic nephropathy is a diabetic complication associated with capillary damage and increased mortality. Sirtuin 4 (SIRT4) plays an important role in mitochondrial function and the pathogenesis of metabolic diseases, including aging kidneys. The aim of the present study was to investigate the association between SIRT4 and diabetic nephropathy in a glucose-induced mouse podocyte model. A CCK-8 assay showed that glucose simulation significantly inhibited podocyte proliferation in a time- and concentration-dependent manner. Reverse transcription-quantitative polymerase chain reaction and western blot analysis showed that the mRNA and protein levels of SIRT4 were notably decreased in a concentration-dependent manner in glucose-simulated podocytes. However, SIRT4 overexpression increased proliferation and suppressed apoptosis, which was accompanied by increases in mitochondrial membrane potential and reduced production of reactive oxygen species (ROS). Notably, SIRT4 overexpression downregulated the expression of apoptosis-related proteins NOX1, Bax and phosphorylated p38 and upregulated the expression of Bcl-2 in glucose-simulated podocytes. In addition, SIRT4 overexpression significantly attenuated the inflammatory response, indicated by reductions in the levels of TNF-α, IL-1ß and IL-6. These results demonstrate for the first time that the overexpression of SIRT4 prevents glucose-induced podocyte apoptosis and ROS production and suggest that podocyte apoptosis represents an early pathological mechanism leading to diabetic nephropathy.

Hydrogen-rich saline improves non­alcoholic fatty liver disease by alleviating oxidative stress and activating hepatic PPARα and PPARγ.

Non-alcoholic fatty liver disease (NAFLD) comprises a range of liver diseases, between steatosis and non­alcoholic steatohepatitis and liver cirrhosis, which are closely associated with diabetes mellitus. Previous studies have indicated that oxidative stress is a key factor in the development of NAFLD. Molecular hydrogen (H2) may ameliorate oxidative stress injuries by selectively neutralizing peroxynitrite and hydroxyl radicals. The present study evaluated the effects of H2 on NAFLD in rats and concluded that H2­rich saline had significant therapeutic effects on NAFLD induced by hyperglycemia and hyperlipidemia, as demonstrated by hematoxylin and eosin and terminal deoxynucleotidyl-transferase­mediated dUTP nick end labeling staining. H2­rich saline improved fasting blood glucose, fasting insulin, insulin sensitivity and glucose tolerance, and lowered the expression levels of tumor necrosis factor alpha, interleukin­1 beta, 3­nitrotyrosine and 8­hydroxy­2'­deoxyguanosine in the liver. In addition, the present study revealed that H2­rich saline could significantly increase peroxisome proliferator­activated receptor (PPAR) α and PPARγ expression in hepatocytes. In conclusion, H2­rich saline may significantly improve NAFLD, possibly by reducing oxidative stress and activating hepatic PPARα and PPARγ expression.

Publication trends of research on diabetes mellitus and T cells (1997-2016): A 20-year bibliometric study.

INTRODUCTION: Diabetes Mellitus (DM) is a huge burden for human health. Recent studies show the close relationship between DM and T cells. We investigated the trend in DM and T cells research. METHODS: Using the Web of Science database, we searched the publications on DM and T cells in 1997-2016, and studied the source data using bibliometric methodology. Excel 2016, GraphPad Prism 5, and VOSviewer software were used to analyze the publication trend in DM and T cells research. RESULTS: We found a total of 1077 publications with 38109 citations up to January 23, 2017. The highest contribution came from the United States, with 48.38% of the publications, 61.44% of the citations and the highest H-index (74). China had the 5th place for total publications, but ranked 11th both for citation frequency (604) and H-index (13). The inflection point of the global DM and T cells publications was in 2000. Journal of Immunology published the most related articles (164). Santamaria P. was the leading scholar in this field with the most publications (35). The keywords "regulatory T cell" and "autoimmune diabetes" were mentioned more than 300 times. Furthermore, type 2 (T2)DM, T cell immunoglobulin and mucin domain (TIM) and obesity are becoming popular research topics in this field. CONCLUSION: The quantity of publications on DM and T cells grew rapidly around year 2000, but has relatively decreased recently. The United States had the leading position in global research. There was a discrepancy between productivity and quality of publications from China. Latest progress is most likely first published by the Journal of Immunology. Santamaria P., Roep B.O. and Peakman M. were the pioneer scholars in this field. Most researchers have focused on "regulatory T cell" and "autoimmune diabetes" research. In future, T2DM, TIM and obesity may be the popular areas.

Global scientific trends on exosome research during 2007-2016: a bibliometric analysis.

BACKGROUND: Exosomes are small vesicles of endosomal origin, and they can be used for the diagnosis and the treatment. However, limited data were for the evaluation of the trend of exosome researches. This study aims to investigate the trend of exosome researches and compare the contribution of research from different regions, organizations and authors. METHODS: Exosome related publications from 2007 to 2016 were retrieved from the Web of Science database. Excel, GraphPad Prism 5 and VOSviewer software were used to analyze the research trend. RESULTS: A total of 1852 papers were identified and were cited 62967 times. The United States accounted for 38.8% of the articles, 42.0% of the citations, and the highest H-index (76). China ranked the second in the number of articles, but the sixth in citation frequency (4337) and the fourth in H-index (36). The journals, PLoS ONE and J Biol Chem had the highest number of publications. The author, Gabrielsson S., has published the most papers in this field (22). The keyword "ribonucleic acid" was mentioned the most at 746 times, and the words, "stem cell", "drug resistance" and "monocyte cell factor" were the latest hotspots appeared around 2015. CONCLUSION: Literature growth related to exosome is expanding rapidly. The quality of the articles from China still requires improvement. Recent studies focus on the relationship with tumor, and "stem cell", "drug resistance" and "michigan cancer foundation-7" may be the newest topics that should be closely followed in exosome research.

Global research trends in spinal ultrasound: a systematic bibliometric analysis.

BACKGROUND: In recent years, there has been increased interest in the use of ultrasound technology in the evaluation of spinal and paraspinal regions. OBJECTIVE: This study aimed to investigate trends in spinal ultrasound research from 1994 to 2015 and compare the contributions of such research from different countries and authors. STUDY DESIGN: Bibliometric analysis. SETTING: Publications related to spinal ultrasound from 1994 to 2015 were retrieved from the Web of Science database. METHODS: Excel 2013, GraphPad Prism 5, and VOSviewer were used to summarise bibliometric features, including the number of publications, citation frequency, H-index, and country contributions and hotspots (keywords of popular scientific fields). RESULTS: A total of 3859 papers were included. The global inflection point (the point in time when the publication growth rate moved from positive to negative) came in 2010. The United States contributed the largest percentage of articles (1041; 26.9%), with the most citations (19 848) and the highest H-index (61). The journals Osteoporosis International and Spine had the highest publication number. The University of Toronto and the University of California, San Francisco were the most contributive institutions. Studies could be divided into three clusters: surgery, osteoporosis, and others. The keywords 'adolescent idiopathic scoliosis' and 'anaesthesia' were the latest hotspots, appearing around 2012. CONCLUSION: Spinal ultrasound literature has grown continuously over the last 22 years, with the rate slowing down after 2010. The United States was the largest contributor in this field. Recent studies on topics related to 'adolescent idiopathic scoliosis' and 'anaesthesia' were relatively new and should be closely followed in spinal ultrasound research.