Objective:To analyze the short-and medium-term clinical outcomes of Mako robotic-assisted posterior-lateral approach in complex primary total hip arthroplasty (THA).Methods:A retrospective case series analysis was conducted on 29 patients with complex hip conditions who underwent Mako robotic-assisted posterior-lateral approach at Department of Orthopaedics, the Second Affiliated Hospital of Zhejiang University School of Medicine from November 2020 to December 2024. The patient cohort included 14 cases of developmental dysplasia of the hip, 8 cases of ankylosed hip, 3 cases of traumatic hip arthritis, 3 cases of sequelae of purulent hip arthritis, and 1 case of synovial chondromatosis. There were 12 males and 17 females, with an age of (62.3±9.4) years (range:44 to 79 years). Surgical time, intraoperative blood loss, vascular and nerve injury, postoperative infection, and other complications were recorded. Preoperative and postoperative lower limb length discrepancy, combined offset difference (ΔCO), acetabular abduction angle, and acetabular anteversion angle were measured. The Harris hip score was recorded at regular follow-ups. Data comparison was conducted using the paired sample t-test. Results:All patients successfully underwent surgery with the Mako robotic system. The surgical time was (107.6±41.5) minutes (range:50 to 235 minutes), and the intraoperative blood loss was (165.5±147.7) ml (range:50 to 800 ml). All patients were followed up for a duration of (27.3±16.7) months (range:3 to 51 months). The planned intraoperative acetabular cup abduction angle was 40.1°±1.6° (range: 36° to 45°), and the measured postoperative acetabular cup abduction angle was 40.2°±3.5° (range: 33° to 54°), with no significant difference ( t=0.231, P=0.819). The planned intraoperative acetabular cup anteversion angle was 19.1°±3.9° (range: 15° to 25°), and the measured postoperative acetabular cup anteversion angle was 18.5°±3.4° (range: 10° to 26°), with no significant difference ( t=1.792, P=0.084). The difference in length of both lower limbs was (-17.6±15.0) mm (range:-50 to 10 mm) before operation and (-1.5±16.0) mm (range:-33 to 53 mm) after operation ( t=6.282, P<0.01)(positive values indicate that the surgical side is longer than the contralateral side). The ΔCO was (4.1±12.0) mm (range:-18 to 30 mm) before operation and (-2.2±13.3) mm (range:-44 to 17 mm) after operation, with statistically significant difference ( t=2.635, P=0.014). One patient experienced vascular injury with embolism postoperatively, while no other complications were observed in the remaining patients. No loosening, dislocation, or fracture of the prosthesis was noted during the follow-up period. The Harris function score was improved from (47.1±8.3) points(range:15 to 62 points) preoperatively to (73.0±5.5) points(range:57 to 83 points) at the three-month postoperative follow-up ( t=22.630, P<0.01). Conclusion:The use of Mako robotic assistance in complex total hip arthroplasty can enhance the accuracy of prosthesis placement, minimize lower limb length discrepancy, and improve hip joint function.

Objective:To analyze the short-and medium-term clinical outcomes of Mako robotic-assisted posterior-lateral approach in complex primary total hip arthroplasty (THA).Methods:A retrospective case series analysis was conducted on 29 patients with complex hip conditions who underwent Mako robotic-assisted posterior-lateral approach at Department of Orthopaedics, the Second Affiliated Hospital of Zhejiang University School of Medicine from November 2020 to December 2024. The patient cohort included 14 cases of developmental dysplasia of the hip, 8 cases of ankylosed hip, 3 cases of traumatic hip arthritis, 3 cases of sequelae of purulent hip arthritis, and 1 case of synovial chondromatosis. There were 12 males and 17 females, with an age of (62.3±9.4) years (range:44 to 79 years). Surgical time, intraoperative blood loss, vascular and nerve injury, postoperative infection, and other complications were recorded. Preoperative and postoperative lower limb length discrepancy, combined offset difference (ΔCO), acetabular abduction angle, and acetabular anteversion angle were measured. The Harris hip score was recorded at regular follow-ups. Data comparison was conducted using the paired sample t-test. Results:All patients successfully underwent surgery with the Mako robotic system. The surgical time was (107.6±41.5) minutes (range:50 to 235 minutes), and the intraoperative blood loss was (165.5±147.7) ml (range:50 to 800 ml). All patients were followed up for a duration of (27.3±16.7) months (range:3 to 51 months). The planned intraoperative acetabular cup abduction angle was 40.1°±1.6° (range: 36° to 45°), and the measured postoperative acetabular cup abduction angle was 40.2°±3.5° (range: 33° to 54°), with no significant difference ( t=0.231, P=0.819). The planned intraoperative acetabular cup anteversion angle was 19.1°±3.9° (range: 15° to 25°), and the measured postoperative acetabular cup anteversion angle was 18.5°±3.4° (range: 10° to 26°), with no significant difference ( t=1.792, P=0.084). The difference in length of both lower limbs was (-17.6±15.0) mm (range:-50 to 10 mm) before operation and (-1.5±16.0) mm (range:-33 to 53 mm) after operation ( t=6.282, P<0.01)(positive values indicate that the surgical side is longer than the contralateral side). The ΔCO was (4.1±12.0) mm (range:-18 to 30 mm) before operation and (-2.2±13.3) mm (range:-44 to 17 mm) after operation, with statistically significant difference ( t=2.635, P=0.014). One patient experienced vascular injury with embolism postoperatively, while no other complications were observed in the remaining patients. No loosening, dislocation, or fracture of the prosthesis was noted during the follow-up period. The Harris function score was improved from (47.1±8.3) points(range:15 to 62 points) preoperatively to (73.0±5.5) points(range:57 to 83 points) at the three-month postoperative follow-up ( t=22.630, P<0.01). Conclusion:The use of Mako robotic assistance in complex total hip arthroplasty can enhance the accuracy of prosthesis placement, minimize lower limb length discrepancy, and improve hip joint function.

Objective To evaluate the effectiveness of filter membranes made from different materials in monitoring the health status of rodents in barrier environment facilities by investigating their microbial capture performance.Methods Pasteurella pneumotropica(Pp)and Staphylococcus aureus(Sa)were used as representative strains to simulate the process of microbial capture by filter membranes under laboratory conditions.The microbial capture effectiveness of five self-selected filter membranes(M1,M2,M3,M4,and M5)with adsorption and breathability properties and a commercial filter membrane(T1)were comprehensively evaluated based on captured dust mass,minimum detection limit,and differences in Ct values obtained through fluorescence quantitative PCR detection.The best-performing self-selected filter membrane was placed in the ventilation ducts of cage racks within the barrier facility,with sentinel mice in corresponding cage racks as the control group.Staphylococcus epidermidis and Escherichia coli were used as indicator bacteria to calculate the positive detection rate and coincidence rate,thereby exploring the feasibility of using microbial capture filter membranes to monitor the health status of experimental animals in barrier facilities.Results In terms of the captured dust mass,the self-selected filter membrane M3(non-woven filter membrane with a diameter of 0.1 μm);showed a capture effectiveness second only to T1,with a capture mass of 0.126 g.For Sa,all filter membranes except M4 had a minimum detection limit of 102 CFU/g.For Pp,the minimum detection limit for all filter membranes was 102 CFU/g.However,the Ct value of the quantitative fluorescence PCR amplification results for M3 was significantly lower than that of other materials,indicating that M3 had the best capture performance among the five self-selected materials.In the filter detection verification experiment,the positive detection rate of Staphylococcus epidermidis in sentinel mouse feces and M3 was 50.00％(6/12)and 58.33％(7/12),respectively,with a coincidence rate of 92％.The positive detection rate of Escherichia coli in both sentinel mouse feces and M3 was 50.00％(6/12),with a coincidence rate of 100％.Conclusion Among the 5 self-selected filter membranes,M3 exhibits the best capturing performance.Within the barrier environment facilities,M3 outperforms sentinel mice in monitoring Staphylococcus epidermidis.Therefore,non-woven filter membrane with a diameter of 0.1 μm;can be used as the material for microbial capture filter membranes,providing valuable insights for the selection and application of microbial capture filter membranes used in PCR monitoring of cage exhaust air dust.

BACKGROUND: China bears the biggest atrial fibrillation (AF) burden in the world. However, little is known about the incidence and predictors of AF. This study aimed to investigate the current incidence of AF and its electrocardiographic (ECG) predictors in general community individuals aged over 60 years in China. METHODS: This was a prospective cohort study, recruiting subjects who were aged over 60 years and underwent annual health checkups from April to July 2015 in four community health centers in Songjiang District, Shanghai, China. The subjects were then followed up from 2015 to 2019 annually. Data on sociodemographic characteristics, medical history, and the resting 12-lead ECG were collected. Kaplan-Meier curve was used for showing the trends in AF incidence and calculating the predictors of AF. Associations of ECG abnormalities and AF incidence were examined using Cox proportional hazard models. RESULTS: This study recruited 18,738 subjects, and 351 (1.87%) developed AF. The overall incidence rate of AF was 5.2/1000 person-years during an observation period of 67,704 person-years. Multivariable Cox regression analysis indicated age (hazard ratio [HR], 1.07; 95% confidence interval [CI]: 1.06-1.09; P < 0.001), male (HR, 1.30; 95% CI: 1.05-1.62; P = 0.018), a history of hypertension (HR, 1.55; 95% CI: 1.23-1.95; P < 0.001), a history of cardiac diseases (HR, 3.23; 95% CI: 2.34-4.45; P < 0.001), atrial premature complex (APC) (HR, 2.82; 95% CI: 2.17-3.68; P < 0.001), atrial flutter (HR, 18.68; 95% CI: 7.37-47.31; P < 0.001), junctional premature complex (JPC) (HR, 3.57; 95% CI: 1.59-8.02; P = 0.002), junctional rhythm (HR, 18.24; 95% CI: 5.83-57.07; P < 0.001), ventricular premature complex (VPC) (HR, 1.76; 95% CI: 1.13-2.75, P = 0.012), short PR interval (HR, 5.49; 95% CI: 1.36-22.19; P = 0.017), right atrial enlargement (HR, 6.22; 95% CI: 1.54-25.14; P = 0.010), and pacing rhythm (HR, 3.99; 95% CI: 1.57-10.14; P = 0.004) were independently associated with the incidence of AF. CONCLUSIONS The present incidence of AF was 5.2/1000 person-years in the studied population aged over 60 years in China. Among various ECG abnormalities, only APC, atrial flutter, JPC, junctional rhythm, short PR interval, VPC, right atrial enlargement, and pacing rhythm were independently associated with AF incidence.
Humans ; Male ; Middle Aged ; Aged ; Atrial Fibrillation/epidemiology* ; Prospective Studies ; Incidence ; Atrial Flutter/complications* ; Risk Factors ; China/epidemiology* ; Electrocardiography

Objective:To investigate the carrier rate and clinical characteristics of epigenetic modification gene mutations (EMMs) among patients with acute myeloid leukemia (AML).Methods:One hundred seventy two patients who were initially diagnosed with AML at the First People′s Hospital of Lianyungang from May 2011 to February 2021 were selected as the study subjects. Next-generation sequencing was carried out to detect variants of 42 myeloid genes among these patients. Clinical and molecular characteristics of patients with EMMs and the effect of demethylation drugs (HMAs) on their survival were analyzed.Results:Among the 172 AML patients, 71 (41.28%) were found to harbor the EMMs, and carrier rates were TET2 (14.53%, 25/172), DNMT3A (11.63%, 20/172), ASXL1 (9.30%, 16/172), IDH2 (9.30%, 16/172), IDH1 (8.14%, 14/172), EZH2 (0.58%, 1/172). Patients with EMMs (+ ) had lower peripheral hemoglobin compared with those with EMMs (-) (72 g/L vs. 88 g/L, Z=-1.985, P<0.05). The proportion of EMMs(+ ) among elderly AML patients was significantly higher than that of young AML patients [71.11% (32/45) vs. 30.70% (39/127), χ2 = 22.38, P < 0.001]. EMMs (+ ) were significantly correlated with NPM1 gene variants ( r=0.413, P < 0.001), while negatively correlated with CEPBA double variants ( r=-0.219, P<0.05). Compared with conventional chemotherapy regimens, HMAs-containing chemotherapy regimens have improved the median progression-free survival (PFS) and median overall survival (OS) among intermediate-risk AML patients with EMMs (+ ) (PFS: 11.5 months vs. 25.5 months, P<0.05; 12.5 months vs. 27 months, P<0.05). Similarly, Compared with conventional chemotherapy regimens, chemotherapy with HMAs had increased median PFS and median OS in elderly AML patients with EMMs(+ ) (4 months vs. 18.5 months, P<0.05; 7 months vs. 23.5 months, P<0.05). Conclusion:Patients with AML have a high rate of EMMs carriage, and HMAs-containing chemotherapy regimens can prolong the survival of elderly patients with AML with poor prognosis, which may provide a reference for individualized treatment.

Objective To explore the association between lipid profiles and left ventricular hypertrophy in a Chinese general population. Methods We conducted a retrospective observational study to investigate the relationship between lipid markers [including triglycerides, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein (HDL) cholesterol, non-HDL-cholesterol, apolipoprotein A-I, apolipoprotein B, lipoprotein[a], and composite lipid profiles] and left ventricular hypertrophy. A total of 309,400 participants of two populations (one from Beijing and another from nationwide) who underwent physical examinations at different health management centers between 2009 and 2018 in China were included in the cross-sectional study. 7,475 participants who had multiple physical examinations and initially did not have left ventricular hypertrophy constituted a longitudinal cohort to analyze the association between lipid markers and the new-onset of left ventricular hypertrophy. Left ventricular hypertrophy was measured by echocardiography and defined as an end-diastolic thickness of the interventricular septum or left ventricle posterior wall > 11 mm. The Logistic regression model was used in the cross-sectional study. Cox model and Cox model with restricted cubic splines were used in the longitudinal cohort. Results In the cross-sectional study, for participants in the highest tertile of each lipid marker compared to the respective lowest, triglycerides [odds ratio (OR): 1.250, 95％CI: 1.060 to 1.474], HDL-cholesterol (OR: 0.780, 95％CI: 0.662 to 0.918), and lipoprotein(a) (OR: 1.311, 95％CI: 1.115 to 1.541) had an association with left ventricular hypertrophy. In the longitudinal cohort, for participants in the highest tertile of each lipid marker at the baseline compared to the respective lowest, triglycerides [hazard ratio (HR): 3.277, 95％CI: 1.720 to 6.244], HDL-cholesterol (HR: 0.516, 95％CI: 0.283 to 0.940), non-HDL-cholesterol (HR: 2.309, 95％CI: 1.296 to 4.112), apolipoprotein B (HR: 2.244, 95％CI: 1.251 to 4.032) showed an association with new-onset left ventricular hypertrophy. In the Cox model with forward stepwise selection, triglycerides were the only lipid markers entered into the final model. Conclusion Lipids levels, especially triglycerides, are associated with left ventricular hypertrophy. Controlling triglycerides level potentiate to be a strategy in harnessing cardiac remodeling but deserve to be further investigated.

Objective:To explore the role of activated CD4 + T cells in cardiac remodeling after myocardial infarction (MI). Methods:① Experiment in vitro: naive CD4 + T cells were isolated in mouse spleen, and then stimulated with plate-bound anti-CD3 and anti-CD28 for 48 hours. Exosomes isolated from the supernatant of activated CD4 + T cells were incubated with cardiac fibroblasts (CFs) for 48 hours, and then the ability of CFs proliferation, migration and differentiation were detected by cell counting kit-8 (CCK-8) assay, Transwell assay, and immunofluorescence assay. ② Experiment in vivo: 40 male C57 mice were divided into 4 groups according to random number table method, including control group (Ctrl group), sham operation group (Sham group), MI group, and exosome treatment group (MI+Exo group), with 10 in each group. The mice model of MI was established by ligating the left anterior descending coronary artery. In MI+Exo group, 40 μg/d exosomes were injected intravenously into the tail after modeling. Cardiac function and cardiac fibrosis post-MI were assessed by echocardiography and quantitative polymerase chain reaction (qPCR) at 4th week. Results:① In vitro: exosomes derived from activated CD4 + T cells significantly promote CFs proliferation, migration and differentiation [proliferation ability ( A value): 0.31±0.01 vs. 0.21±0.01, migration capability (cells/MP): 79.20±3.34 vs. 48.80±2.13, differentiation ability (α-smooth muscle actin, α-SMA; fluorescence intensity): 1.56±0.03 vs. 1.00±0.02, all P < 0.05]. ② In vivo: echocardiographic analysis showed that exosomes derived from activated CD4 + T cells aggravated the deterioration of cardiac dysfunction post-MI than MI group, as indicated by left ventricular ejection fraction (LVEF) and fractional shortening (FS) decreased significantly [LVEF: 0.185±0.008 vs. 0.257±0.022, FS: (9.72±1.72)% vs. (14.08±1.08)%, both P < 0.05], left ventricular end-diastolic diameter (LVEDD) and left ventricular end-systolic diameter (LVESD) increased significantly [LVEDD (mm): 5.43±0.29 vs. 4.62±0.35, LVESD (mm): 4.94±0.12 vs. 3.69±0.29, both P < 0.05]. Additionally, qPCR showed that exosomes derived from activated CD4 + T cells remarkably promoted myocardial fibrosis post-MI than MI group, as indicated by the mRNA expression of α-SMA, collagens (Col1a1, Col3a1) in MI+Exo group was significantly higher than that in MI group [α-SMA (2 -ΔΔCT): 4.72±0.89 vs. 3.58±0.78, Col1a1 (2 -ΔΔCT): 6.59±0.56 vs. 4.23±0.42, Col3a1 (2 -ΔΔCT): 13.40±1.03 vs.4.96±0.36, all P < 0.05]. Conclusion:Activated CD4 + T cells promote cardiac remodeling following MI through transferring exosomes to CFs.

Objective:To analyze the epidemiological and etiological characteristics of a dengue fever outbreak in Hunan province in 2018.Methods:Real-time PCR assay was performed for the laboratory diagnosis of 8 suspected dengue fever cases. Etiological surveillance was performed in 186 suspected dengue fever cases and fever cases who had close contacts with dengue fever patients. C6/36 cells was used for the virus isolation from acute phase serum. By sequencing the full length of E genes of 15 dengue virus strains, phylogenetic analysis was performed based on the sequences obtained, including reference sequences from the NCBI GenBank database, the serotypes and gene subtypes of the virus were analyzed to trace the possible source of transmission. An emergency monitoring of vector density and a retrospective survey of sero-epidemiology in healthy population were conducted in the epidemic area.Results:In the serum samples of 8 suspected patients, 6 were dengue virus RNA positive, and 4 were NS1 antigen positive. In 186 suspected patients, 96 were dengue virus nucleic acid, NS1 antigen or antibody positive in etiological test. A total of 64 dengue virus strains were isolated. The phylogenetic analysis showed that all the dengue virus strains belonged to type 2, which might be from Guangdong or Zhejiang provinces. The Bretub index was up to 65, indicating an extremely high risk of transmission. The positive rate of the dengue virus IgG antibody was 0.53%(2/377) in retrospective survey of 377 healthy people.Conclusion:The field epidemiologic and the molecular genetics analyses showed the outbreak of dengue fever in Hunan in 2018 was caused by imported cases and dengue virus 2.

Objective:To confirm the first imported Chikungunya fever (CHIK) epidemic in Hunan province.Methods:Serum samples of patients and colleagues were collected. The nucleic acids of Dengue virus (DENV), Yellow fever virus (YFV), Chikungunya virus (CHIKV) were detected by real- time fluorescent quantitative PCR. The positive PCR products were sequenced. Phylogenetic tree was constructed.Results:The serum samples of the patient and one of the five colleagues were positive for CHIKV. The Blast comparison of gene sequence showed 99% homology with CHIKV sequences. The infected CHIKV belonged to ECSA genotype in the phylogenetic tree.Conclusions:The first imported CHIK epidemic in Hunan province was confirmed through the epidemiological survey and etiologic detection.

Objective: To make etiological diagnosis and evaluate the protective effects of post-exposure prophylaxis(PEP) in an event of one dog injured seven persons. Methods: Direct immunofluorescence assay (DFA) and nested polymerase chain reaction (PCR) were employed to detect nucleoprotein and nucleoprotein(N) gene of rabies virus in the brain tissues of the dog, the positive samples were sequenced for the full length of N gene of rabies virus, then the homology of the N gene of rabies virus was analyzed after the phylogenetic tree was constructed. Rapid fluorescent focus inhibition test (RFFIT) was applied to detect the rabies virus neutralizing antibodies(RVNA) on day 0, 14 and 40 after PEP. Results: The cerebral, cerebellar and hippocampal tissues were positive by DFA and nested PCR. The phylogenetic tree indicated the rabies virus belonged to the rabies virus genotype I. The homology of the nucleotide and amino acid of the rabies virus N gene were over 86% with the vaccine strains. The titer of the RVNA increased significantly from the day 0 to day 14 after PEP, the lowest was 5.78 IU/ml and the highest was 26.15 IU/ml. On the day 40, the highest RVNA titer was 51.96 IU/ml. No rabies cases occurred in a one year follow-up visit. Conclusions Normative PEP can effectively prevent the occurrence of rabies cases.