Periprosthetic osteolysis and aseptic loosening after total hip arthroplasty are the common causes for revision surgery,which are initiated by wear particles released from the articular surfaces of prosthetic components.These components include ultra-high molecular weight polyethylene,titanium alloy,Al2O3,ZrO2 and polymethylmethacrylate.Wear particles activate macrophage via phagocytosis or pattern recognition receptor,resulting in release of inflammatory mediators such as macrophage colony-stimulating factor (M-CSF),macrophage chemotactic protein-1 (MCP-1),macrophage inhibitory protein-1 (MIP-1),IL-1β,IL-6 and TNF-α.Furthermore,wear particles stimulate M0 macrophage to polarize to M1 macrophage,promoting the release of inflammatory mediators.The periprosthetic osteolysis process is a cell/cytokine-mediated biological cascade induced by macrophage activation,involving the monocyte/macrophage cell line,such as macrophages,osteoclasts,and dendritic cells.The mesenchymal cells,including osteoblasts,osteocytes,fibroblasts and lymphocytes,lead to a deviation in the balance of osteoblast-osteoclast interactions within the basic multicellular unit,resulting in periprosthetic osteolysis.Fibrobalst,dendritic,and lymphocyte cells can enhance the recruitment and activation of macrophages by secreting MCP-1,MIP-1,and IL-8.Furthermore,the upregulated expression of RANKL,TNF-α,and IL-1 β facilitates the osteoclast differentiation from osteoclast precursor.TNF-α,IL-1 β together with wear particles can upregulate the expression of IL-6,MCP-1 and M-CSF of osteoblast and promote the recruitment and activation of macrophages.Nuclear transcriptional factor NF-κB plays a vital role in mediating periprosthetic inflammatory response and gene expression of bone metabolism.Different inflammatory factors can induce different expression of its downstream gene,ultimately,promoting or hindering the osteolysis process.The individual difference of periprosthetic osteolysis may also relate to single nucleotide polymorphism of IL-1RA,IL-6 and MMP-1 gene.

Objective To discuss the operational technique and clinical effect of metallic stent placement in treating malignant gastroduodenal obstruction.Methods Metallic stent placement under fluoroscopic monitoring and endoscopic direct vision was performed in 47 patients with malignant gastroduodenal obstruction.A total of 54 metallic stents was used.Results The procedure was successfully completed in all 47 patients.During the follow-up period,all the patients could take liquid or ordinary diet and were markedly relived of vomiting.The living quality was much improved and no serious complications occurred.Conclusion Under fluoroscopic monitoring and endoscopic direct vision,stent placement is a safe,effective,technically-simple and time-saving procedure for the treatment of malignant gastroduodenal obstruction with less sufferings to the patient.Therefore,it is definitely worth popularizing this technique in clinical practice.

Objective To observe the effect of polyethylene terephthalates (PET) coated with 58S bioactive glass on graft-bone healing.Methods The PET coated with 58S bioactive glass was used in experimental group,and uncoated PET was used as a control.The coating solution was made of 20％ bioactive glass powder and 80％ gelatin powder (by weight).In our vitro study,4×104/ml MT3T3-E1 cells were cultured in 24-well plates with the coated or uncoated PET,and the MTT and ALP were tested at 1,3,5 days to show the proliferation and the activity of the cells.The SEM and the X-ray photoelectron spectrometer were adopted to analyze the surface characteristics of the fiber.In our vivo study,24 skeletally mature New Zealand white rabbits were randomly divided into two groups,the 58S-PET group and the PET group.Both groups underwent a surgical procedure to establish a tibia-articular tendon-bone healing model.Mechanical examination and histological assay were taken to verify the coating effect in vivo.Results The 58S-PET group showed significantly differences in both the MTT and ALP tests at each time point (3,5 days) compared with the PET group.In the animal experiments,the maximum load increased by time in both groups.At 6 weeks,the load-to-failure was significantly higher in the 58S-PET group [(61.70±6.95) N]than that of the PET group [(45.21±9.78) N].At 12 weeks,the load-to-failure was also significantly higher in the 58S-PET group [(89.25±9.50) N]than that of the PET group [(71.38±6.26) N].In the histological assay,it was found that there was new bone formation in the indistinct interface between the graft and the host bone in both groups at 6,12 weeks,and a stronger binding was seen in the 58S-PET group than in the PET group.Conclusion The 58S-PET could enhance the proliferation and activity of the osteoblast and therefore promote the new bone formation and subsequently leads to a positive effect on tendon-bone healing.

Objective To investigate the effects of exogenous glial cell derived neurotrophic factor (GDNF)on colon glial cells in slow transit constipation (STC ) rats,and to explore the optimal concentration of GDNF in order to provide evidence for intestinal neurotrophic therapy in the treatment of STC.Methods A total of 132 SD rats were divided into STC group and control group,66 rats in each group.STC rats were established by feeding with rhubarb.Six rats were randomly selected from either groups to verify whether STC model was successfully established.And the left 120 rats of two groups were randomly divided into six subgroups:STC group one to group six and control group one to group six,ten rats in each group,which were untreated,injected through tail vein with saline,and 0.001 ,0.010, 0.050,0.100 μg/L GDNF 2 mL respectively for one week.The expression of Sox-8 at protein level of either group were detected by Western blotting.Independent sample t test was performed for statistical analysis.Results After treated with 0.001 μg/L GDNF (STC group three),there was no significant
difference in expression level of Sox-8 between STC group three and STC group one (13.38 ±0.70 vs 13.39±0.45 ,t = 0.042,P = 0.969 ).After treated with 0.010 μg/L GDNF (STC group four),the difference in expression level of Sox-8 between STC group four and STC group three was significant (21 .11 ±2.56 vs 13.38±0.70,t=5 .040,P <0.01).After treated with 0.050 μg/mL GDNF (STC group five),the expression level of Sox-8 was higher than that in STC group four (31.86±1.57 vs 21.11±2.56,t=-6.198,P <0.01 ).The Sox-8 expression of untreated,saline treated,0.001 and 0.050 μg/L GDNF treated STC rats (STC group one,two,three and five)were lower than those of the corresponding control groups (t= 3.394,12.103,10.302,- 6.120,all P < 0.05 ).Conclusion Exogenous GDNF could increase Sox-8 expression in colon tissue of STC rats,an increase in the number of colon glial cells could repair enteric nervous system,and 0.050 μg/L was the optimal concentration.

Objective: To identify the optimal placement of bone tunnel during near-isometric anterior cruciate ligament reconstruction (ACLR), and its dimensional relationship with knee anatomic structure after summarizing published researches. Methods: PubMed, Embase, and CNKI were screened for Chinese or English articles on clinical studies, cadaveric studies of knee and reviews on bone tunnel placement in anterior cruciate ligament near-isometric reconstruction and isometry of native anatomic fibers. Related articles were extracted and systematically reviewed. Results: A total of 21 articles were finally included after screening. This systematic review found that most of the literatures were cadaveric studies, among which three dimensional imaging techniques, combined with cadaveric studies, were commonly used as a method of determining the length change between spots on the tibial plateau and lateral condyle of femur in recent years. There were 3 case series and 1 prospective cohort study. On the side of lateral condyle of femur, Blumensaat's line, lateral intercondylar ridge and insertion of intact anterior cruciate ligament were commonly used as reference to describe the near isometric area, while on the side of tibial plateau, the anterior horn of lateral meniscus were used as reference for reconstruction. The bone tunnel on tibial side was ignored compared with the femoral side when considering the isometry of reconstruction. There were overlaps among areas of bone tunnel placement found by different studies in near-isometric reconstruction. Not all native anterior cruciate ligament fibers were near-isometric. Conclusion The present study found that the area of femoral bone tunnel of anterior cruciate ligament near-isometric reconstruction were near the anterior part of lateral intercondylar ridge, deeply positioned with longitudinal axis close to the extension line of posterior cortical part of femur, coinciding with the distribution of direct fibers. There was contradiction on whether anterior cruciate ligament near-isometric reconstruction areas and anterior cruciate ligament anatomic insertion sites overlapped with each other. The most isometric area within the anatomic insertion site was the area of anterior fibers near lateral intercondylar ridge, which carried a large portion of the total anterior cruciate ligament load. Generally, there was a scarce of clinical researches in the field of isometry of ACLR. For the purpose of attesting the accuracy of the results we found, a combination of intra-operative observation on the displacement of graft relative to bone-tunnel and post-operative imaging such as MRI and three dimensional CT should be considered.

Objective To explore the changes in gene expression and biological process of the osteoarthritis (OA) induced by anterior cruciate ligament (ACL) transection and partial medial meniscectomy,so as to provide bioinformatic basis for further studying the molecular mechanism of OA.Methods The gene chip datasets of a rat model of early 0A induced by ACL transection and partial medial meniscectomy were downloaded from GEO databases (submitted by Appleton,et al.).The differential expression genes (DEGs)were identified,and the Gene ontology(GO) as well as the Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses for DEGs were conducted using bioinformatic methods.Results A total of 170 DEGs including 97 up-regulated genes and 73 down-regulated genes were identified.The up-regulated genes were mainly enriched in the extracellular matrix (ECM) and were closely related to the ECM-receptor interaction,while the down-regulated genes were mainly enriched in the biological function of muscle contraction and were linked with the peroxisome proliferators-activated receptor (PPAR) signaling pathway.Conclusion The changes of ECM and muscle contraction play a key role in the occurrence and development of OA.The ECM-receptor interaction and PPAR signaling pathway are strongly associated with OA and worthy of further study.

Objective: To assess plantar arch index (AI) and prevalence of flat feet in school-age children (7-12 years old) in Shanghai and evaluate the relationship between flat feet with age, gender, weight status (BMI) and occurring sides, and to provide a reference for the prevention of flatfeet. Methods: Three-dimensional foot measuring instruments were used to measure bilateral foot length, medial arch height, AI and arch height ratio (AHR) in school-age children in Shanghai. Statistical analysis of these foot parameters was performed. Results: A total of 3 226 children between aged 7 and 12 in Shanghai were measured with AI of (0.27±0.05) and AHR of (3.02±1.89). Prevalence of flat feet in the group of 7 to 12 year old children was 56.1%. Prevalence of flatfeet decreased significantly with age: 72.6% at 7 years old and 37.9% at 12 years old. Boys had a significantly greater risk for flat feet than girls: the prevalence of flat feet was 62.9% for boys and 47.8% for girls (OR=1.81, 95%CI=1.57-2.10). This risk was independent of age but related to gender. The risk of flat feet in boys was always higher than that in girls at every age. For children aged 7-8, being overweight was not significantly related to the occurrence of flat feet. However, for children aged 9-12 who were overweight were more likely to have flat feet than those of normal weight. The OR increased with age: from 1.44 (95%CI=1.03-2.03) at 9 to 2.96 (95%CI=1.68-5.23) at 12. There was no difference on which side flat feet would occur (χ2=0.95，P=0.33). Conclusion This finding shows that prevalence of flat feet is influenced by age, gender and weight status. AI and prevalence of flat feet in children aged 7-12 decreases with age, and boys have significantly higher prevalence of flat feet than girls. Overweight children aged 9 or older have a higher risk of flat feet.

Background: and Purpose Patients with aortic disease might have an increased risk of intracranial aneurysm (IA). We conducted this research to assess the prevalence of IA in patients with aortopathy, considering the impact of gender, age, and cardiovascular risk factors. Methods: We searched PubMed and Scopus from inception to August 2019 for epidemiological studies reporting the prevalence of IA in patients with aortopathy. Random-effect meta-analyses were performed to calculate the overall prevalence, and the effect of risk factors on the prevalence was also evaluated. Anatomical location of IAs in patients suffered from distinct aortic disease was extracted and further analyzed. Results: Thirteen cross-sectional studies involving 4,041 participants were included in this systematic review. We reported an estimated prevalence of 12% (95% confidence interval [CI], 9% to 14%) of IA in patients with aortopathy. The pooled prevalence of IA in patients with bicuspid aortic valve, coarctation of the aorta, aortic aneurysm, and aortic dissection was 8% (95% CI, 6% to 10%), 10% (95% CI, 7% to 14%), 12% (95% CI, 9% to 15%), and 23% (95% CI, 12% to 34%), respectively. Gender (female) and smoking are risk factors related to an increased risk of IA. The anatomical distribution of IAs was heterogeneously between participants with different aortic disease. Conclusions According to current epidemiological evidence, the prevalence of IA in patients with aortic disease is quadrupled compared to that in the general population, which suggests that an early IA screening should be considered among patients with aortic disease for timely diagnosis and treatment of IA.

Objectives:To analyze the potential biomarkers of behavioral and psychological symptoms of dementia (BPSD) in patients with Alzheimer′s disease (AD) continuum.Methods:A prospective cohort study was consecutively conducted on 179 patients with AD continuum (135 presented with BPSD, 44 patients without BPSD as control) from Capital Medical University, Beijing Tiantan Hospital, the Chinese imaging biomarkers and lifestyle cohort between January 1, 2021 and December 31, 2022. Gender, age, body max index, education level, diagnosis, the apolipoprotein E epsilon4 allele (APOE ε4) carrier status, the scores of the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA), cerebrospinal fluid (CSF) AD-related pathological biomarkers (Aβ 42, Aβ 40, Aβ 42/40, tTau, pTau181), and blood biomarkers (white blood cell count, red blood cell count, hemoglobin, platelet, total bilirubin, albumin, total cholesterol, triglyceride, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, fasting glucose, erythrocyte sedimentation rate, homocysteine, vitamin B 12, folate) were compared between the two groups by using hypothesis testing and univariate logistic regression analysis. Multivariate logistic regression analysis was used to analyze the potential biomarkers associated with BPSD in patients with AD. Results:Among the 179 patients with AD continuum in the final analysis, 77 patients were men, 102 cases were women; 35 patients were identified with mild cognitive impairment (MCI) due to AD and 144 patients with AD dementia stage, the mean age was (66.54±9.75) years. Compared with those in control group, patients with BPSD had lower cerebrospinal fluid (CSF) Aβ 40 and blood hemoglobin levels [7.08 (4.42, 15.42) vs 9.62 (6.45, 12.12) pg/L, (132.70±13.37) vs (138.80±14.38) g/L] ( U=-1.856, t=2.579, P<0.05). The levels of CSF Aβ 40 ( OR=0.030, 95% CI: 0.001-0.760) and blood hemoglobin ( OR=0.051, 95% CI: 0.004-0.670) were independently negatively associated with BPSD in patients with AD continuum (both P<0.05). Conclusion:The decreased levels of CSF Aβ 40 and blood hemoglobin could be considered as potential biomarkers in detecting BPSD in patients with AD continuum.

Ojective To explore the effect of the hydroxyapatite(HAp)and gelatin(Gel)coating on the healing of the polyethylene terephthalate(PET)artificial ligament.Methods The artificial ligaments were divided into a PET group with a pure PET surface and a PET/HAp/Gel group coated with HAp and Gel.Both coatings were observed using the scanning electron microscope(SEM).Forty-eight male New Zealand rabbits were randomly divided into two groups and underwent anterior cruciate ligament reconstruction,before two kinds of artificial ligaments were implanted respectively.Four weeks and 8 weeks after the operation,the rabbits were sacrificed,and histological hematoxylin and eosin (HE)staining as well as the biomechanical examination were performed.Results HAp/Gel coating was found depositing on the surface of PET artificial ligaments.Histological HE staining showed a thick fibrous connective tissue forming at the graft-host bone interface 4 weeks postoperatively,and the interface width of both groups were narrowed,with significantly more shrinking in the PET/HAp/Gel coating group.And new bone tissues were found in the interface of PET/HAp/Gel group 8 weeks after the operation.The biomechanical examination found significant differences in the failure load between the PET(46.16 ± 2.88 N) and PET/HAp/Gel group(71.32 ± 3.92 N)8 weeks after the surgery(P=0.0021).And 4 weeks and 8 weeks after the surgery,significant differences were found in the stiffness between the PET group and the PET/HAp/Gel group(11.06 ± 1.14 N/mm vs 16.20 ± 1.17 N/mm,P=0.0199;14.37 ± 0.88 N/mm vs 24.35 ± 1.35 N/mm,P=0.0008).Conclusion HAp/Gel coating can enhance the osteogenesis of PET artificial ligaments,promoting the new bone formation at the graft-host bone interface and herein strengthening the graft-host bone healing.