Bone loss is often presented in the revision of total hip arthroplasty.The selection of appropriate materials to repair bone deficiency in the revision of total hip arthroplasty requires an understanding of the special bioactivity of the materials.The materials provide the bioactivity of osteogenesis,osteoinduction,osteoconduction and mechanical support.The article give a review of the bioactivity and future applications of the materials in repairing bone deficiency in the revision of total hip arthroplasty.

Osteogenic protein-1(OP-1),also referred to as bone morphogenetic protein-7(BMP-7),has the effective osteoinduction.In reconstructive surgery of the hip,OP-1 could induce greater and earlier new bone formation,accelerate the incorporation of the graft and host-bone,and enfance the fixation of the plant.The characteristics in the molecular biology and it's application in reconstructive surgery of the hip was reviewed.

ObjectiveTo investigate fecal diversion in the management of pelvic fractures associated with perineal injuries.MethodsThis retrospective study involved 27 patients of pelvic fractures associated with perineal injuries during April 2005 to April 2011.There were 23 males and 4 females,and the mean age was 32.9 years old (range,16-62 years old).Fractures type according to Tile classification:4 cases were type A,10 cases were type B,and 13 cases were type C.The pelvic external fixator and fecal diversion were selectively used.Results Of the 27 patients of pelvic fractures associated with perineal injuries,24survived.The overall mortality of pelvic fractures associated with perineal injuries in the present study was 11％.The survived 24 patients were totally reviewed clinically.The mean follow-up time of these patients was 10.9 months (range,4-42 months).Of those patients who underwent early fecal diversion (＜ 48 h),none experienced infectious completions.However,of those underwent non-early (＞48 h) fecal diversion (including those who did not undergo fecal diversion),four patients experienced infectious completions.Fisher's exact test was used to compare the infection rate of these two groups.And the result of Fisher's exact test demonstrated that those patients who underwent early (＜ 48 h) fecal diversion and non-early (＞48 h) fecal diversion (including those who did not undergo fecal diversion).ConclusionStabilization of hemodynamic; selective fecal diversion; early stabilization of pelvic fracture are necessary for the emergency management of pelvic fractures associated with perineal injuries.Rectal injury and severe perineal injury without involvement of rectum should undergo fecal diversion.Early fecal diversion (＜ 48 h) could reduce the infection rate of pelvic fractures associated with perineal injuries.

Objective To understand colonization of pathogens in nasal vestibular of health care workers (HCWs) in intensive care unit (ICU),and provide evidence for strengthening the prevention and control of healthcare-associated infection (HAI)in ICU.Methods On may 2015,colonization status of pathogens in nasal vestibular of uninfected HCWs in ICU were actively screened,bacterial culture,isolation and identification were performed.The surveyed results were analyzed and compared with antimicrobial resistance of pathogens from patients at the same stage.Results A total of 96 HCWs were surveyed,43 pathogenic strains were isolated from different HCWs’na-sal vestibular,isolation rate and carriage rate were both 44.79%.The main pathogenic bacteria was Staphylococcus aureus(n=15,34.88%),followed by Enterobacter aerogenes (n =9,20.93%)and Klebsiella pneumoniae (K . pneumoniae ,n=7,16.28%).There was a high detection rate of pathogens from nasal vestibular of doctors,HCWs who smoked frequently and those who never exercised (all P <0.05).There were 1 strain of imipenem-resistant K . pneumoniae among 43 pathogenic strains.Resistance rate of 7 K .pneumoniae from HCWs to ampicillin/sulbactam, cefazolin,and furantoin were all >50.00%,resistance rates to cefotaxime and imipenem were 28.57% and 14.29%respectively;resistance rates of 11 strains of K .pneumoniae from patients to furantoin was 100.00% during the same stage,but were sensitive to other commonly used antimicrobial agents.Resistance rate of 4 strains of Esche-richia coli (E.coli)to ampicillin was 75.00%,to gentamicin,tobramycin,levofloxacin,ciprofloxacin,and com-pound sulfamethoxazole were all 50.00%,6 strains of E.coli isolated from patients during the same period were found to be resistant to most commonly used antimicrobial agents.Conclusion Colonization rate of pathogens is high in nasal vestibular of HCWs in ICU,active screening and monitoring on colonization of pathogens in HCWs’ nasal vestibular is significant for preventing the occurrence and cross transmission of HAI among HCWs and pa-tients.

Objective To understand the specimen sources,clinical characteristics,and antimicrobial resistance of Burkholderia cepacia (B .cepacia )isolated from infected patients in intensive care unit(ICU),so as to provide reference for guiding rational use of antimicrobial agents.Methods Clinical data of patients with B .cepacia infec-tion in an ICU between 2011 and 2014 were analyzed retrospectively,antimicrobial resistance of strains was ana-lyzed.Results A total of 267 B .cepacia strains were isolated,the major specimen sources were sputum (80.15%, n=214),blood(14.23%,n =38),and urine(3.37%,n =9).Antimicrobial susceptibility testing results revealed that B .cepacia had multiple resistance,and was naturally resistant to multiple clinically used antimicrobial agents, such as ampicillin,cefazolin,ampicillin/sulbactam,nitrofurantoin,and cefuroxime,resistant rates were all 100%;resistant rates to ceftazidime and levofloxacin were 4.12% and 3.00% respectively;resistant rate to compound sulfa-methoxazole had increased tendency(χ2 =5.885,P =0.015).Conclusion Isolation of B .cepacia in ICU increased year by year,antimicrobial resistance is serious,management and targeted monitoring of prevention and control of healthcare-associated infection should be strengthened,antimicrobial agents should be chosen according to antimi-crobial susceptibility testing results.

BACKGROUND:There are various commonly used interbody fusion methods, such as autologous bone,
al ograft bone and titanium-based posterior lumbar interbody fusion, and each method has its own advantages and disadvantages.
OBJECTIVE:To observe the clinical efficacy of a bioactive nano-hydroxyapatite/polyamide 66 fusion cage in posterior lumbar interbody fusion for the treatment of lumbar disease.
METHODS:A retrospective case analysis was conducted on 16 cases treated with posterior lumbar interbody
fusion at the Department of Orthopedic, the First Affiliated Hospital of Gannan Medical University from July 2010 to December 2011, and al the patients were implanted with nano-hydroxyapatite/polyamide 66 biological activity fusion cage.
RESULTS AND CONCLUSION:Al the patients were fol owed-up for 10-24 months, and the lumbar pain was significant improved, the lumbar visual analogue score, lumbar Japanese Orthopaedic Association score and Oswestry disability index score were significantly improved during the final fol ow-up period (P<0.05). No internal fixation loosing or broken observed in al the patients during final fol ow-up, and al the patients obtained bone
fusion without nano-hydroxyapatite/polyamide 66 fusion cage displacement or subsidence. The results indicate that nano-hydroxyapatite/polyamide 66 fusion cage for the treatment of posterior lumbar interbody fusion can
reconstruct the lumbar stability and provide immediate stability after implantation, and has good biological activity.

Osteoporosis seriously threatens the living quality of people, especially the elderly, and causes a huge economic burden to society. In the past, bisphosphonates, denosumab and other first-line drugs were used in the treatment of osteoporosis. However, these drugs can only inhibit bone resorption, but can not promote bone formation. Studies have shown that mesenchymal stem cells (MSCs) can be used to treat osteoporosis, however, it has some defects and deficiencies, such as genetic instability, limited cell survival and increased risk of cancer. However, mesenchymal stem cell-derived exosomes (MSCs-Exos) can regulate the differentiation and proliferation of osteoblasts by mediating wingless and int-1 (Wnt)/β-catenin and mitogen-activated protein kinase (MAPK) signaling pathways, promote bone regeneration, and thus has an impact on osteoporosis. In this paper, preclinical studies on MSCs and MSCs-Exos in the treatment of osteoporosis in recent years were reviewed, in order to provide a new idea for the treatment of osteoporosis.

BACKGROUND:Extracellular vesicles can regulate insulin resistance and control inflammatory response by participating in intercellular communication,while repairing skeletal muscles and promoting skeletal muscle regeneration,which is expected to be a novel treatment modality for sarcopenic obesity. OBJECTIVE:To review the biogenesis of extracellular vesicles,their biological functions,their relationship with sarcopenic obesity,and recent advances in the pathogenesis,diagnosis,and treatment of sarcopenic obesity. METHODS:The first author performed a computer search of PubMed,Embase,CNKI and other databases for relevant studies involving extracellular vesicle in sarcopenic obesity.The search keywords were"extracellular vesicle,exosome,sarcopenic obesity,obese sarcopenia,skeletal muscle regeneration,skeletal muscle mass regulation"in English and Chinese,respectively.The search period was from June 2022 to November 2022.After screening,87 articles were included for further review. RESULTS AND CONCLUSION:Extracellular vesicles are important vectors of bidirectional cell communication and participate in the regulation of normal physiological and pathological processes through autocrine,paracrine and endocrine ways.Sarcopenic obesity is a complex multi-factor disease.Extracellular vesicles are involved in the occurrence and development of sarcopenic obesity mainly by regulating the inflammatory response of skeletal muscle and the homeostasis of muscle cells.Cytokines secreted by adipose tissue and skeletal muscle are released into the extracellular circulation through extracellular vesicle encapsulation and interact with each other to promote skeletal muscle insulin resistance and lipogenesis,which is the main pathophysiology of skeletal muscle atrophy in sarcopenic obesity.Extracellular vesicles not only promote the development of sarcopenic obesity by providing specific pathogenic markers,but also are a valuable diagnostic indicator of sarcopenic obesity.Release of extracellular vesicles from skeletal muscle during exercise enhances metabolic response and promotes skeletal muscle regeneration.Extracellular vesicles can not only be used as therapeutic targets for sarcopenic obesity but also be used to treat sarcopenic obesity by loading drugs to effectively improve drug bioavailability.

Objective To investigate the chemical composition from the flowers of Callerya speciosa,and reveal the metabolites difference at different flowering periods based on metabolomics technology.Methods The primary and secondary metabolites,volatile chemical components in flowers of C.speciosa were analyzed combined by GC-MS and UPLC-Q-Exactive MS.Principal component analysis(PCA),orthogonal partial least squares-discriminant analysis(OPLS-DA),and hierarchical cluster analysis(HCA)were performed to identify differential metabolites.Results A total of 332 compounds were identified by UPLC-Q-Exactive MS,mainly including secondary metabolites such as flavonoids,triterpenoids,phenylpropanoids.A total of 297 compounds were identified by GC-MS,mainly including primary metabolites and volatile chemical components,such as organic acids,amino acids,saccharides,heterocycles,alcohols.The PCA analysis demonstrated that the metabolites of the four flowering periods were divided into two groups:bud,initial bloom and blooming periods clustered into one group,while wilting period clustered into the other group,the main differences were filtered and identified as flavonoids and triterpenoids,organic acids,respectively.Compared to the upright type,the flowers of vine type contained more characteristic flavonoids as differential metabolites during the bud,initial bloom and blooming periods,and some flavonoids decrease gradually with the development of flowering.Conclusion The results indicated that the flowers of C.speciosa possessed abundant active flavonoid metabolites for further utilization,and the best harvest stage is initial bloom,the best harvest plant is vine type.This study provides a scientific basis for the scientific development and rational use of the flowers of C.speciosa.

BACKGROUNDPelvic fractures are uncommon in elderly patients and so are infrequently addressed in the literature. The purpose of this study was to investigate the management and outcome of pelvic fractures in elderly patients.

METHODSWe retrospectively reviewed the records of pelvic fractures in elderly patients (age ≥55 years) who were treated in our department from September 1997 to May 2010.

RESULTSA total of 40 elderly patients with pelvic fractures were identified. Their mean age was 65.8 years (range 55-87 years). About 68% (n = 27) were men. The average Injury Severity Score (ISS) was 17.8 (range 6-45). Twelve (30%) patients required blood transfusion (mean 10 units) during the first 24 hours. The fractures were most frequently due to falling from a standing position (48%). Almost half (48%) were grade I breaks. Associated injuries were present in 70% (n = 28) of patients, and 65% (n = 26) had medical co-morbidities. Altogether, 29 patients (73%) underwent non-surgical management of their pelvic fracture. The average hospital stay was 25 days. There were five in-hospital deaths and one death 10 months after discharge. High ISSs (>25) were associated with increased in-hospital mortality (P = 0.018). At the final assessment (mean follow-up 15 months), 52% of the surviving patients had experienced decreased self-sufficiency.

CONCLUSIONSPelvic fractures in elderly patients result in high morbidity and mortality rates. A high ISS (>25) can be used to identify a patient at high risk. We recommend aggressive resuscitation and intensive care for that patient. For patients with an unstable pelvic or displaced acetabular fracture (≥2 mm) who can endure surgery, open reduction and internal fixation can provide adequate fixation for early weight-bearing and restoration of the bone stock.

Aged ; Aged, 80 and over ; Blood Transfusion ; Female ; Fracture Fixation, Internal ; Fractures, Bone ; etiology ; surgery ; therapy ; Hospital Mortality ; Humans ; Male ; Middle Aged ; Pelvic Bones ; injuries ; Retrospective Studies