BACKGROUND: Periprosthetic infection after total hip replacement usually results in surgery failure and needs a second operation.OBJECTIVE: To explore the pathogenesis, diagnosis and treatment of periprosthetic infection after total hip replacement by-reviewing and summarizing articles published in recent years.METHODS: A computed-based online search of Pubmed database was performed by using the key words of total hip arthroplasty, infection for manuscripts published from January 1990 to December 2010 and of those in SpringerLink database between January 1,1970 and December 31, 2010. A total of 2 109 manuscripts were retrieved. Moreover, related book or manuscripts that published by high-impact journals were included. Totally, 29 manuscripts were included. RESULTS AND CONCLUSION: The formation of biofilms on the surface of prosthesis is the main cause for hardly eradicated. Resistant bacteria and polymicrobial infection seems to be an increasing tendency. A correct diagnosis as soon as possible is very important to prognosis. However, without a gold-standard way, each mean has advantages and shortages, and comprehensive considerations are necessary. lnterleukin-6 seems a good choice for its inexpensive, non-invasive and a high sensitivity and specificity, which has aroused increasing attention. The antibiotics only, debridement with retention, one-stage replacement, two-stage replacement, joint arthrodesis, even amputation, are used to treat infection after total hip replacement. Prophylactic antibiotics are important to prevent infection. Antibiotic-loaded acrylic cement seems to be reliable and accept for more and more patients. However, each option must be selected according to the presence of infection individually.

BACKGROUND: It is difficult to revise replacement due to infection-induced osteodeficiency, osteoporosis, soft tissue lost orcicatrization.OBJECTIVE: To establish the standardized clinical prevention and treatment methods by summarizing the new progress to prevent, diagnosis of the infection, and its effective treatment, as well as rehabilitation evaluation after total Knee replacement. METHODS: A computer-based online search of CNKI and PUBMED database between January 1990 and December 2010 was performed to search related articles with the key words of total knee arthroplasty, infection. A total of 2 346 articles were retrieved. Moreover, related works were manually searched. Totally, 30 articles were included.RESULTS AND CONCLUSION: It is better to prevent infection rather than treatment after total knee replacement. Currently, there is lack of a clear diagnosis standard on the infection. In treatment aspect, debridement, revision surgery, and choosing effective antibiotics can effectively control the infection. Meantime, new methods are expected to improve the success rate of infection after total knee replacement. Exercise is a continuation of rehabilitation therapy and an important step in treatment. Therefore, on the basis of total knee replacement, it is important to establish the early prevention of postoperative infection, early diagnosis, effective treatment and rehabilitation evaluation system, in order to minimize the incidence of infection and treat infections timely and effectively.

BACKGROUND: There are many criteria used to evaluate the curative effects of hip-preserving treatment for osteonecrosis of the femoral head (ONFH), and there have been no consistent criteria, so the curative effects of hip-preserving treatment lack comparability to some extent. OBJECTIVE: To review and analyze a variety of criteria for evaluating the curative effects of hip-preserving treatment and to develop a specific quality of life scale of hip-preserving treatment. METHODS: A computer-based retrieval of Pubmed database using key words "osteonecrosis, femoral head, quality of life", or "osteonecrosis, femoral head, curative effect" for manuscripts published from August 2000 to August 2010 and of CNKI database for manuscripts published from January 1994 to December 2009 using key words "femoral head necrosis, curative effect" or "femoral head necrosis, quality of life". Manuscripts that address hip-preserving treatment of ONFH and related quality of life or manuscripts that were recently published or in the high-impact journals were included in this paper. Finally, 31 manuscripts were reviewed.RESULTS AND CONCLUSION: The current criteria for evaluating the curative effects of hip-preserving treatment focus on pain, function, and range of motion of hip joints, but do not lay emphasis on the local changes of hip joints or lower limbs, which can not sufficiently reflect the overall quality of life of patients. The SF-36 scale lack specificity to some extents and cannot be used to evaluate the curative effects of hip-preserving treatment systemically and specifically. Therefore, it is necessary to develop a specific quality of life scale for evaluating the curative effects of hip-preserving treatment of ONFH.

0.05).However,there existed a better effect on relieving TCM syndrome in group A than that in group B,though the effect of group A on relieving pain was inferior to that of group B(P

BACKGROUND: Bone marrow mesenchymal stem cells (MSCs) have been widely accepted by medical investigators due to their advantages including easy obtaining, minimal invasion, with infinite proliferation and multi-differential potential, and without immunological rejection in the autologous transplantation. OBJECTIVE: The goal of this study is to isolate and purify rat bone marrow MSCs in vitro, so as to observe the effects of different concentrations of serum containing kidney-tonifying and blood-activating Chinese herbs on the in vitro proliferation of rat bone marrow MSCs.DESIGN: A randomized controlled animal experiment.SETTING: Hip Center, First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine.MATERIALS: Forty healthy male SD rats of SPF grade, weighing 170 to 180 g, were provided by the Laboratory Animal Center, Guangzhou University of Traditional Chinese Medicine. The protocol was performed in accordance with ethics guidelines for the use and care of animals. The involved rats were divided into 4 groups by random digit table with 10 rats in each: normal control group, high-, middle-, and low-concentration groups. METHODS: This study was performed at the Laboratory Animal Center, Guangzhou University of Traditional Chinese Medicine between January and March 2005. Rat bone marrow MSCs were isolated and purified by Percoll density gradient centrifugation, and cultured in vitro to establish rat bone marrow MSCs culture system. Rats in the high-, middle-, and low-concentration groups were intragastrically administrated with 4.4, 2.2 and 1.1 g/kg serum containing kidney-tonifying and blood-activating Chinese herbs, which equaled to 20, 10 and 5 times of adult dosage, respectively. Rats in the normal control group were intragastrically administrated with purified water for 1 week. One hour after the last administration, 6 mL blood was taken from abdominal aorta of each rat under the aseptic condition. Then, it was centrifuged at 2 000 r/min for 15 minutes, and meanwhile serum was collected. 10% rat serum containing kidney-tonifying and blood-activating Chinese herbs was added to the medium in the high-, middle-, and low-concentration groups, while 10% fetal bovine serum was added in the normal control group. MAIN OUTCOME MEASURES: ① MSCs growth status; ② MSCs morphology was observed by HE staining and Giemsa's staining; ③ MSCs antigen expression was detected by an immunocytochemical method; ④ Effects of different concentrations of serum containing kidney-tonifying and blood-activating Chinese herbs on MSCs growth.RESULTS: ①The primarily cultured bone marrow MSCs began to adhere to the wall 24 hours later and 80% of them reached the confluence 7 days later. ② MSCs took appearance in long shuttle shape or polygon. These cells were little. Nuclei were located in the middle part of cells or a little deviation. The ratio of nucleus to cytoplasm was a little high. ③CD44 expression was found in the cytoplasm of mononuclear cells, and colored blue. Partial MSCs expressed c-Kit. Their cytomorphology and phenotypic expression have the characteristics of MSCs. ④Three days after serum containing kidney-tonifying and blood-activating Chinese herbal medicine being added to high-, middle-, and low-concentration groups, the number of bone marrow MSCs was dose-dependently increased as compared with that in the normal control group. CONCLUSION: Serum containing kidney-tonifying and blood-activating Chinese herbs promotes the in vitro proliferation of bone marrow MSCs.

BACKGROUND:Cartilage injury is stil one of the clinical problems difficult to be treated completely so far. Recently, the discovery of synovial mesenchymal stem cells (SMSCs) has brought about the new hope to cartilage repair.
OBJECTIVE:To explore the process concerning SMSCs-based therapy for cartilage repair in the past few years, such as the characteristics of SMSCs, culture conditions, preclinical and clinical studies, and then to summarize the literatures published in recent years.
METHODS:A computed-based online search of PubMed and SpringerLink databases was performed using the key words of“synovial mesenchymal stem cells, cartilage repair”for literatures published from January 1993 to May 2013.
RESULTS AND CONCLUSION:Final y, 37 articles were included. SMSCs have a greater proliferative capability, colony-forming potential and chondrogenic potential than other mesenchymal stem cells. The diseases such as osteoarthritis and rheumatoid arthritis can influence the characteristics of SMSCs. Numerous articles have aimed at the studies of cellculture in vitro and celltransplantation in vivo. However, the process of SMSCs therapy is mostly at its preliminary stage. Reports on its unique characteristics, optimal culture conditions and the high-quality clinical studies are stil largely lacking. In a word, though further studies are needed, SMSCs appear to be a promising cellsource for cartilage repair in the future.

BACKGROUND:In order to avoid heterotopic ossification after total hip arthroplasty, nonsteroidal anti-inflammatory drugs are commonly used for prevention.
OBJECTIVE:To compare the effect of meloxicam and indomethacin in the prevention of heterotopic ossification after total hip arthroplasty.
METHODS:Fifty-one patients who treated in the Department of Orthopedics, the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine from 2010 to 2011 were col ected. Among the 51 patients, nine patients were treated with bilateral total hip arthroplasty, and al the patients had total hip arthroplasty with the posterior-lateral approach. The patients were divided into the control group and the experimental group according to the drugs used after replacement, and the patients in the two groups were administered with indomethacin sustained-release tablet 25 mg+omeprazole capsule 20 mg or meloxicam tablet 15 mg after replacement.
RESULTS AND CONCLUSION:There were no significant differences in the incidence of heterotopic ossification, pain, modified D’Aubigne and Postel scores after replacement between two groups (P>0.05). But, the gastrointestinal adverse reactions of the experimental group were less than those of the control group. The application of meloxicam only can effectively avoid the heterotopic ossification and release pain. Consequently, we recommend meloxicam as postoperative drug for the prevention of heterotopic ossification and pain remission fol owing total hip arthroplasty.

OBJECTIVETo identify risk factors of hepatocellular carcinoma (HCC) in cirrhotic patients with chronic hepatitis B (CHB).

METHODSA total of 715 cirrhotic patients with CHB were recruited from the Zhongshan Hospital Affiliated to Fudan University and enrolled in this case-control study between January 2009 and September 2014. All participants were Chinese Han residing in Shanghai and the surrounding areas. The patients were divided into a cirrhosis group (n =281) and a HCC group (n=434). History of hepatitis B infection and HCC, as well as clinical data from serological, imaging and pathological examinations were collected for analysis.SPSS software, version 19.0, was used for all statistical comparisons.

RESULTSSingle factor analysis indicated that development of HCC in cirrhotic patients with CHB was significantly associated with male sex, age of 50 years or more, family history of HCC, alcohol consumption,fatty liver, detectable levels of hepatitis B virus (HBV) DNA, and history of HBV infection without effective antiviral treatment. Multivariate logistic regression analysis indicated that age of 50 years or more (P =0.005, odds ratio [OR] =1.766), history of alcohol consumption (P =0.002, Or = 2.570), family history of HCC (P =0.014, Or = 2.268), fatty liver (P =0.023, Or = 3.390), and history of HBV infection without effective antiviral treatment (P < 0.001,Or = 5.389) were risk factors of HCC.The risk factors for development of HCC in cirrhotic patients with hepatitis B after achieving sustained virologic suppression (SVS) were family history of HBV infection (P =0.014, Or = 2.537), family history of HCC (P =0.037,Or = 3.339) and fatty liver (P =0.018, Or = 11.646).

CONCLUSIONRisk factors of HCC in cirrhotic patients with CHB include age,drinking history,family history of HCC, fatty liver, and ineffective antiviral treatment of CHB.Family history of HBV infection or HCC, and fatty liver disease, were significantly associated with HCC development after SVS in patients with hepatitis B-related cirrhosis.

Alcohol Drinking ; Antiviral Agents ; Carcinoma, Hepatocellular ; Case-Control Studies ; China ; Fatty Liver ; Hepatitis B virus ; Hepatitis B, Chronic ; Humans ; Liver Cirrhosis ; Liver Neoplasms ; Male ; Odds Ratio ; Risk Factors

Objective To analyze the clinical characteristics and treatment strategy of phosphaturic mesenchymal tumors in hips.Methods From May 2017 to November 2017,five patients with phosphaturic mesenchymal tumors in hips,who treated in our hospital were retrospectively reviewed.The clinical manifestations,laboratory inspection,radiological examination,pathological examination and treatment were analyzed.Results Two male cases (40％) and 3 female (60％) were included.The overall age was 49～63 years old (average 54.40±5.37 years old).The course was 19～101 months (average 51.20±32.41months).Four cases of tumor were located in femoral head and 1 case was in femur intertrochanteric region.The maximum tumor diameter was 0.76～1.83 cm (average 1.28±0.39 cm).The early clinical manifestations of the patients were mainly non-specific bone pain or fatigue.The symptoms of the hip were not obvious.All patients had been misdiagnosed.After pathological frac-ture of the hip,the patient suffered from hip pain,thigh pain,fatigue,etc.,or limited hip function.The severe patients had a systemic multiple pathologic fractures.The serum phosphorus was lower than normal in preoperative period and recovered to normal level in 3-8 days after surgery.The postoperative ALP decreased significantly than preoperative in 4 patients and 1 case was slightly higher than preoperative.Preoperative 1,25-(OH)2-D3 and PTH were in normal range.99Tcm-octreotide (OCT) scan or 68Ga DOTA-TATE PET/CT can detect the disease.X-ray,CT and MRI can identify the lesions.The lesions of femoral head were basically under the joint surface,with a nodular change.Part of the tumor was infiltrating and close to the cortex.The pathology was mainly manifested as a large number of thin-walled vessels in the bone trabeculae.There were dense spindle cells or astrocytes between the blood vessels and the atypia is not obvious.Three patients were treated with total hip arthroplasty and two with segmental resection and bone graft.After surgical removal of the tumor,the patient's systemic pain or anemic symptoms were gradually relieved and the joint function was restored.Meanwhile,the bone density was increased.Conclusion The clinical features of the phosphaturic mesenchymal tumors in hips were not obvious.Comprehensive diagnosis should be carried out in combination with the clinical manifestations,laboratory examination,radiological examination and pathological examination.Total hip arthroplasty or segmental resection with bone graft can effectively remove the tumor and achieve good prognosis.

BACKGROUND: Obtaining synovial fluid for diagnostic test of periprosthetic joint infection is invasive and painful to patients. Platelet count is a regular blood test which has been used as a possible predictor of several infectious diseases. Presumably, it could be one of the indicators of periprosthetic joint infection. OBJECTIVE: To identify the accuracies of platelet combined with white blood cell, erythrocyte sedimentation rate or C-reactive protein in the diagnosis of periprosthetic joint infection. METHODS: Patients undergoing revision arthroplasty from March 2013 to December 2018 in the First Affiliated Hospital of Guangzhou University of Chinese Medicine were retrospectively enrolled. A diagnosis of periprosthetic joint infection was confirmed in 77 patients according to the criterions from the Musculoskeletal Infection Society; the remaining 137 patients were confirmed as aseptic cases. White blood cell, erythrocyte sedimentation rate, or C-reactive protein and platelet count were compared between the two groups. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated. RESULTS AND CONCLUSION: The platelet values were significantly increased in periprosthetic joint infection cases. Sensitivity and specificity of the platelet for periprosthetic joint infection were 64.94％ and 86.13％, respectively. Platelet demonstrated a higher accuracy when compared to erythrocyte sedimentation rate and C-reactive protein. In such cases, the platelet shows a certain reference value in confirming the diagnosis of periprosthetic joint infection. Platelet was enough used as adjunct diagnostic tool in patients suspected with periprosthetic joint infection.