Objective To determine the knee joint cartilage thickness using different methods and explore the feasibility of mathematical statistical models of dataset for the prediction of cartilage thickness.Methods A total of 304 patients diagnosed as knee osteoarthritis(OA)combined with varus deformity and undergoing unilateral total knee arthroplasty at the Second Affiliated Hospital of Army Medical University from March 2023 to March 2024 were selected for the study.All patients had complete preoperative and postoperative clinical data.The healthy cartilage at four anatomical sites of patients,including the distal femur lateral condyle,lateral tibial plateau,posterior medial femoral condyle,and posterior lateral femoral condyle were selected,and the knee joint cartilage thickness was determined based on preoperative MRI analysis,robotic navigation system tracing,tissue section of surgical specimen and digital vernier caliper.The baseline indicators of demographics,disease and imaging ffor patients were collected to construct a dataset,and four models of linear regression analysis,principal component analysis,Least Absolute Shrinkage and Selection Operator(LASSO)regression analysis,and K-nearest neighbors(KNN)analysis were established for predicting the accuracy,determination coefficient(R2)and root mean square error(RMSE),and the regression equation for predicting cartilage thickness was established.Results The knee joint cartilage thicknesses determined by preoperative MRI analysis,robotic navigation system tracing,tissue section of surgical specimen had no statistically significant difference with that by digital vernier caliper(P>0.05).The predictive efficiencies of models of linear regression analysis,principal component analysis,and LASSO regression analysis for the knee joint cartilage thickness all failed to meet the expectations(R2<0.3,RMSE>0.03).The predictive effect of KNN model on the cartilage thickness of the distal femur lateral condyle and lateral tibial plateau was not ideal(R2=0.23,RMSE=0.29),while it had potential predictive value(accuracy=0.21,accuracy=0.15).Conclusion The prediction model of knee joint cartilage thickness based on individual parameters has certain scientificity,and the feasibility of KNN model is relatively high.However,due to insufficient sample size and unclear individual parameter weight,the efficiencies of the four established prediction models are not ideal,which fails to provide definite prediction equations.Therefore,the construction scheme of the prediction model still needs to be further optimized.

Objective:To explore the safety and efficacy of intraosseous regional administration (IORA) of vancomycin for preventing infection in primary total knee arthroplasty (TKA).Methods:A total of 124 patients with knee osteoarthritis undergoing TKA between February 2024 and May 2024 at nine hospitals were enrolled. Preoperative infection prophylaxis involved either IORA (0.5 g vancomycin administered via intraosseous regional infusion before incision) or intravenous infusion (1 g vancomycin via peripheral vein). The IORA group included 15 males and 47 females with a median age of 66.5 years (range, 60.0-70.0 years), while the intravenous group included 14 males and 48 females with a median age of 66.0 years (range, 61.8-70.3 years) years. Intraoperative samples were collected including fat and synovium tissues after incision, before prosthesis placement, and after tourniquet release; distal femoral cancellous bone during femoral osteotomy; proximal tibial cancellous bone during tibial osteotomy; proximal intercondylar cancellous bone before prosthesis placement; and peripheral blood from non-infused arms at surgery initiation and after tourniquet release. Vancomycin concentrations were measured using liquid chromatography-tandem mass spectrometry. Vital sign changes were recorded from admission to 5~10 minutes post-IORA (IORA group) or post-incision (intravenous group). Follow-ups were conducted on postoperative day 1 and 3, and at 1 and 3 months, to document complications including IORA-related adverse events, periprosthetic joint infections, surgical site infections, red man syndrome, acute kidney injury, deep vein thrombosis and so on.Results:Vancomycin concentrations in bone, fat, and synovial tissue samples were significantly higher in the IORA group than in the intravenous group ( P<0.05), while vancomycin concentrations in blood samples were significantly lower in the IORA group than in the intravenous group ( P<0.05). Only 7.3%(41/558) of tissue samples in the IORA group had vancomycin concentrations below 2.0 μg/g (the minimum inhibitory concentration of vancomycin against coagulase-negative staphylococcus), compared to 59.3%(331/558) in the intravenous group (χ 2=11.285, P<0.001). In the intravenous group, 16.9%(21/124) of blood samples had vancomycin concentrations exceeding 15.0 mg/L (the threshold associated with a significantly increased risk of nephrotoxicity), while all concentrations in the IORA group were below this threshold, the difference was statistically significant (χ 2=22.943, P<0.001). There were no statistically significant difference ( P>0.05) in vital signs changes before and after vancomycin administration between the two groups. Two patients in the intravenous group experienced incision exudate, while no other related complications occurred in either group. Conclusions:Compared to the traditional intravenous infusion of 1 g vancomycin, intraosseous injection of a low dose (0.5 g) of vancomycin achieves higher local tissue concentrations in the knee joint with a lower incidence of adverse reactions and is safe for infection prophylaxis. Despite guidelines not recommending the routine use of vancomycin for preventing infection after primary TKA, intraosseous injection of 0.5 g vancomycin may be considered intraoperatively for primary TKA in the following scenarios: patients in medical institutions with a high prevalence of methicillin-resistant staphylococcus aureus (MRSA) infections, patients with potential preoperative MRSA colonization, or patients with cephalosporin allergy.

Objective:To explore the safety and efficacy of intraosseous regional administration (IORA) of vancomycin for preventing infection in primary total knee arthroplasty (TKA).Methods:A total of 124 patients with knee osteoarthritis undergoing TKA between February 2024 and May 2024 at nine hospitals were enrolled. Preoperative infection prophylaxis involved either IORA (0.5 g vancomycin administered via intraosseous regional infusion before incision) or intravenous infusion (1 g vancomycin via peripheral vein). The IORA group included 15 males and 47 females with a median age of 66.5 years (range, 60.0-70.0 years), while the intravenous group included 14 males and 48 females with a median age of 66.0 years (range, 61.8-70.3 years) years. Intraoperative samples were collected including fat and synovium tissues after incision, before prosthesis placement, and after tourniquet release; distal femoral cancellous bone during femoral osteotomy; proximal tibial cancellous bone during tibial osteotomy; proximal intercondylar cancellous bone before prosthesis placement; and peripheral blood from non-infused arms at surgery initiation and after tourniquet release. Vancomycin concentrations were measured using liquid chromatography-tandem mass spectrometry. Vital sign changes were recorded from admission to 5~10 minutes post-IORA (IORA group) or post-incision (intravenous group). Follow-ups were conducted on postoperative day 1 and 3, and at 1 and 3 months, to document complications including IORA-related adverse events, periprosthetic joint infections, surgical site infections, red man syndrome, acute kidney injury, deep vein thrombosis and so on.Results:Vancomycin concentrations in bone, fat, and synovial tissue samples were significantly higher in the IORA group than in the intravenous group ( P<0.05), while vancomycin concentrations in blood samples were significantly lower in the IORA group than in the intravenous group ( P<0.05). Only 7.3%(41/558) of tissue samples in the IORA group had vancomycin concentrations below 2.0 μg/g (the minimum inhibitory concentration of vancomycin against coagulase-negative staphylococcus), compared to 59.3%(331/558) in the intravenous group (χ 2=11.285, P<0.001). In the intravenous group, 16.9%(21/124) of blood samples had vancomycin concentrations exceeding 15.0 mg/L (the threshold associated with a significantly increased risk of nephrotoxicity), while all concentrations in the IORA group were below this threshold, the difference was statistically significant (χ 2=22.943, P<0.001). There were no statistically significant difference ( P>0.05) in vital signs changes before and after vancomycin administration between the two groups. Two patients in the intravenous group experienced incision exudate, while no other related complications occurred in either group. Conclusions:Compared to the traditional intravenous infusion of 1 g vancomycin, intraosseous injection of a low dose (0.5 g) of vancomycin achieves higher local tissue concentrations in the knee joint with a lower incidence of adverse reactions and is safe for infection prophylaxis. Despite guidelines not recommending the routine use of vancomycin for preventing infection after primary TKA, intraosseous injection of 0.5 g vancomycin may be considered intraoperatively for primary TKA in the following scenarios: patients in medical institutions with a high prevalence of methicillin-resistant staphylococcus aureus (MRSA) infections, patients with potential preoperative MRSA colonization, or patients with cephalosporin allergy.

Objective To establish a stable,reliable,and clinically relevant porcine model of endotoxin-induced acute respiratory distress syndrome(ARDS).Methods Ten 8-month-old male Bama minipigs were deeply sedated,followed by invasive mechanical ventilation and electrocardiographic monitoring.Lipopolysaccharide(LPS)was intravenously pumped at 600 μg/(kg·h)for 3 hours,then maintained at 15 μg/(kg·h)thereafter.Dynamic monitoring was performed at five time points after LPS injection(LPS 0,1,3,5,and 8 h),including arterial blood gas analysis and chest computed tomography(CT)scans.Pathological examination of lung tissues obtained via bronchoscopic biopsy(HE staining and transmission electron microscopy)was conducted.These indicators were comprehensively used to evaluate the success of the animal model.Results At 5 hours after LPS administration,8 minipigs developed symptoms such as skin cyanosis,elevated body temperature,and respiratory distress.The oxygenation index decreased to<300 mmHg.Chest CT scans showed diffuse pulmonary infiltrates.Histopathology revealed alveolar edema and hyaline membrane formation.Transmission electron microscopy demonstrated disruption of pulmonary blood-air barrier,depletion of lamellar bodies in type Ⅱ pneumocytes,inflammatory cell infiltration,and exudation of plasma proteins and fibrin.Compared with LPS 0 h,at LPS 8 h,the oxygenation index and arterial blood pH were significantly decreased(P<0.001),while blood lactic acid and serum potassium were significantly increased(P<0.05);serum calcium and base excess were significantly decreased(P<0.05),and the lung injury score based on HE-stained lung sections was significantly increased(P<0.01).Conclusion The porcine ARDS model established by continuous LPS injection can dynamically simulate the pathophysiological characteristics and typical pathological manifestations of clinical septic ARDS,making it an effective tool to study the pathogenesis,prevention,and treatment strategies of septic ARDS.

PURPOSE: To investigate the protective effect of sub-hypothermic mechanical perfusion combined with membrane lung oxygenation on ischemic hypoxic injury of yorkshire brain tissue caused by traumatic blood loss. METHODS: This article performed a random controlled trial. Brain tissue of 7 yorkshire was selected and divided into the sub-low temperature anterograde machine perfusion group (n = 4) and the blank control group (n = 3) using the random number table method. A yorkshire model of brain tissue injury induced by traumatic blood loss was established. Firstly, the perfusion temperature and blood oxygen saturation were monitored in real-time during the perfusion process. The number of red blood cells, hemoglobin content, NA⁺, K⁺, and Ca²⁺ ions concentrations and pH of the perfusate were detected. Following perfusion, we specifically examined the parietal lobe to assess its water content. The prefrontal cortex and hippocampus were then dissected for histological evaluation, allowing us to investigate potential regional differences in tissue injury. The blank control group was sampled directly before perfusion. All statistical analyses and graphs were performed using GraphPad Prism 8.0 Student t-test. All tests were two-sided, and p value of less than 0.05 was considered to indicate statistical significance. RESULTS: The contents of red blood cells and hemoglobin during perfusion were maintained at normal levels but more red blood cells were destroyed 3 h after the perfusion. The blood oxygen saturation of the perfusion group was maintained at 95% - 98%. NA⁺ and K⁺ concentrations were normal most of the time during perfusion but increased significantly at about 4 h. The Ca²⁺ concentration remained within the normal range at each period. Glucose levels were slightly higher than the baseline level. The pH of the perfusion solution was slightly lower at the beginning of perfusion, and then gradually increased to the normal level. The water content of brain tissue in the sub-low and docile perfusion group was 78.95% ± 0.39%, which was significantly higher than that in the control group (75.27% ± 0.55%, t = 10.49, p < 0.001), and the difference was statistically significant. Compared with the blank control group, the structure and morphology of pyramidal neurons in the prefrontal cortex and CA1 region of the hippocampal gyrus were similar, and their integrity was better. The structural integrity of granulosa neurons was destroyed and cell edema increased in the perfusion group compared with the blank control group. Immunofluorescence staining for glail fibrillary acidic protein and Iba1, markers of glial cells, revealed well-preserved cell structures in the perfusion group. While there were indications of abnormal cellular activity, the analysis showed no significant difference in axon thickness or integrity compared to the 1-h blank control group. CONCLUSIONS Mild hypothermic machine perfusion can improve ischemia and hypoxia injury of yorkshire brain tissue caused by traumatic blood loss and delay the necrosis and apoptosis of yorkshire brain tissue by continuous oxygen supply, maintaining ion homeostasis and reducing tissue metabolism level.
Animals ; Perfusion/methods* ; Disease Models, Animal ; Brain Injuries/etiology* ; Swine ; Male ; Hypothermia, Induced/methods*

Objective To determine the knee joint cartilage thickness using different methods and explore the feasibility of mathematical statistical models of dataset for the prediction of cartilage thickness.Methods A total of 304 patients diagnosed as knee osteoarthritis(OA)combined with varus deformity and undergoing unilateral total knee arthroplasty at the Second Affiliated Hospital of Army Medical University from March 2023 to March 2024 were selected for the study.All patients had complete preoperative and postoperative clinical data.The healthy cartilage at four anatomical sites of patients,including the distal femur lateral condyle,lateral tibial plateau,posterior medial femoral condyle,and posterior lateral femoral condyle were selected,and the knee joint cartilage thickness was determined based on preoperative MRI analysis,robotic navigation system tracing,tissue section of surgical specimen and digital vernier caliper.The baseline indicators of demographics,disease and imaging ffor patients were collected to construct a dataset,and four models of linear regression analysis,principal component analysis,Least Absolute Shrinkage and Selection Operator(LASSO)regression analysis,and K-nearest neighbors(KNN)analysis were established for predicting the accuracy,determination coefficient(R2)and root mean square error(RMSE),and the regression equation for predicting cartilage thickness was established.Results The knee joint cartilage thicknesses determined by preoperative MRI analysis,robotic navigation system tracing,tissue section of surgical specimen had no statistically significant difference with that by digital vernier caliper(P>0.05).The predictive efficiencies of models of linear regression analysis,principal component analysis,and LASSO regression analysis for the knee joint cartilage thickness all failed to meet the expectations(R2<0.3,RMSE>0.03).The predictive effect of KNN model on the cartilage thickness of the distal femur lateral condyle and lateral tibial plateau was not ideal(R2=0.23,RMSE=0.29),while it had potential predictive value(accuracy=0.21,accuracy=0.15).Conclusion The prediction model of knee joint cartilage thickness based on individual parameters has certain scientificity,and the feasibility of KNN model is relatively high.However,due to insufficient sample size and unclear individual parameter weight,the efficiencies of the four established prediction models are not ideal,which fails to provide definite prediction equations.Therefore,the construction scheme of the prediction model still needs to be further optimized.

This study was aimed at exploring the infections and viral genetic characteristics in rodents from coastal cities in Fujian Province.Intestinal tissue samples were obtained from rodents in Ningde,Fuzhou,Quanzhou,and Zhangzhou city.The adenovirus DNA polymerase(DPOL)gene was analyzed by nested PCR,and the large(L)segment gene of arenavirus was as-sessed with RT-PCR.Homology and genetic characteristics were analyzed in bioinformatics software.A total of 152 rodents were captured and showed a murine adenovirus infection rate of 4.61％.The murine adenovirus infection rate was 5.26％in wild rodents and 4.21％in domestic rodents.Murine adenoviruses were detected in four rodent species:Rattus sladeni,Rattus nor-vegicus,Rattus tanezumi,and Rattus losea.This was the first time that murine adenovirus has been detected in Rattus slade-ni.Analysis of relevant factors revealed no significant differences in murine adenovirus infection rates by rodent species,sex,age,and habitat.Sequence analysis indicated that the adenoviruses infecting rodents in coastal cities of Fujian were Murine ade-novirus 2 and Murine adenovirus 3.A significant difference was observed in the sequences of murine adenoviruses with respect to those in other regions,with nucleic acid sequence identity ranging from 72.25％to 91.01％.No arenavirus was detected in any rodent specimens.Adenovirus infections were found in rodents in coastal cities of Fujian Province,but no arenavirus infec-tions were found.This study provides useful information to support further research on murine adenovirus and arenavirus in Fujian Province.

Objective To investigate the effects of Sacoharomyces boulardii combined with ursodeoxycholic acid on serum levels of gamma-glutamate transpeptidase(γ-GT),insulin like growth factor-1(IGF-1)and retinol binding protein(RBP)in neonates with hyperbilirubinemia.Methods Neonatal hyperbilirubinemia children were divided into control group and treatment group by cohort method.The control group was given ursodeoxycholic acid,5 mg·kg-1 each time,twice a day,and took the tablet powder in warm water;the treatment group was additionally treated with Sacoharomyces boulardii on the basis of the control group,1 bag each time,orally once every 24 h.The clinical efficacy,yellows regression,serum total bilirubin(TBIL),indirect bilirubin(IBIL),transferrin(TRF)levels and serum γ-GT,IGF-1 and RBP levels before and after treatment were compared between the two groups.And evaluated the safety.Results 152 cases in treatment group and 148 cases in control group were enrolled.After treatment,the clinical efficacy of the treatment group and control group was 94.08％(143 cases/152 cases)and 81.76％(121 cases/148 cases);the re-phototherapy rate was 8.55％(13 cases/152 cases)and 20.95％(31 cases/148 cases),the difference was statistically significant(all P＜0.05).The duration of phototherapy in the treatment group and control group were(20.17±5.32)and(26.39±7.69)h;the decolorization time were(3.97±0.60)and(5.59±0.83)d;the hospital stay were(7.17±0.66)and(9.16±0.90)d;the TBIL were(133.26±15.69)and(179.15±17.65)μmol·L-1;the IBIL were(141.88±18.19)and(198.65±19.26)μmol·L-1;the γ-GT were(38.19±3.75)and(50.87±4.25)U·L-1;the RBP were(20.42±3.21)and(25.50±3.43)mg·L-1;the IGF-1 were(20.43±3.06)and(26.51±3.38)ng·L-1;the TRF were(1.98±0.27)and(1.65±0.20)g·L-1,the difference was statistically significant(all P＜0.05).The adverse drug reactions of treatment group and control group were diarrhea,nausea and vomiting,rash.The total incidence of adverse reactions in treatment group and control group was 8.52％(13 cases/152 cases)and 9.46％(14 cases/148 cases),there was no significant difference in the incidence of adverse reactions between the two groups(P＞0.05).Conclusion The treatment of neonatal hyperbilirubinemia with yeast burra combined with ursodeoxychonic acid can effectively improve the levels of serum γ-GT,IGF-1 and RBP,and the clinical efficacy is good.

This study was aimed at exploring the infections and viral genetic characteristics in rodents from coastal cities in Fujian Province.Intestinal tissue samples were obtained from rodents in Ningde,Fuzhou,Quanzhou,and Zhangzhou city.The adenovirus DNA polymerase(DPOL)gene was analyzed by nested PCR,and the large(L)segment gene of arenavirus was as-sessed with RT-PCR.Homology and genetic characteristics were analyzed in bioinformatics software.A total of 152 rodents were captured and showed a murine adenovirus infection rate of 4.61％.The murine adenovirus infection rate was 5.26％in wild rodents and 4.21％in domestic rodents.Murine adenoviruses were detected in four rodent species:Rattus sladeni,Rattus nor-vegicus,Rattus tanezumi,and Rattus losea.This was the first time that murine adenovirus has been detected in Rattus slade-ni.Analysis of relevant factors revealed no significant differences in murine adenovirus infection rates by rodent species,sex,age,and habitat.Sequence analysis indicated that the adenoviruses infecting rodents in coastal cities of Fujian were Murine ade-novirus 2 and Murine adenovirus 3.A significant difference was observed in the sequences of murine adenoviruses with respect to those in other regions,with nucleic acid sequence identity ranging from 72.25％to 91.01％.No arenavirus was detected in any rodent specimens.Adenovirus infections were found in rodents in coastal cities of Fujian Province,but no arenavirus infec-tions were found.This study provides useful information to support further research on murine adenovirus and arenavirus in Fujian Province.

Objective To investigate the effects of Sacoharomyces boulardii combined with ursodeoxycholic acid on serum levels of gamma-glutamate transpeptidase(γ-GT),insulin like growth factor-1(IGF-1)and retinol binding protein(RBP)in neonates with hyperbilirubinemia.Methods Neonatal hyperbilirubinemia children were divided into control group and treatment group by cohort method.The control group was given ursodeoxycholic acid,5 mg·kg-1 each time,twice a day,and took the tablet powder in warm water;the treatment group was additionally treated with Sacoharomyces boulardii on the basis of the control group,1 bag each time,orally once every 24 h.The clinical efficacy,yellows regression,serum total bilirubin(TBIL),indirect bilirubin(IBIL),transferrin(TRF)levels and serum γ-GT,IGF-1 and RBP levels before and after treatment were compared between the two groups.And evaluated the safety.Results 152 cases in treatment group and 148 cases in control group were enrolled.After treatment,the clinical efficacy of the treatment group and control group was 94.08％(143 cases/152 cases)and 81.76％(121 cases/148 cases);the re-phototherapy rate was 8.55％(13 cases/152 cases)and 20.95％(31 cases/148 cases),the difference was statistically significant(all P＜0.05).The duration of phototherapy in the treatment group and control group were(20.17±5.32)and(26.39±7.69)h;the decolorization time were(3.97±0.60)and(5.59±0.83)d;the hospital stay were(7.17±0.66)and(9.16±0.90)d;the TBIL were(133.26±15.69)and(179.15±17.65)μmol·L-1;the IBIL were(141.88±18.19)and(198.65±19.26)μmol·L-1;the γ-GT were(38.19±3.75)and(50.87±4.25)U·L-1;the RBP were(20.42±3.21)and(25.50±3.43)mg·L-1;the IGF-1 were(20.43±3.06)and(26.51±3.38)ng·L-1;the TRF were(1.98±0.27)and(1.65±0.20)g·L-1,the difference was statistically significant(all P＜0.05).The adverse drug reactions of treatment group and control group were diarrhea,nausea and vomiting,rash.The total incidence of adverse reactions in treatment group and control group was 8.52％(13 cases/152 cases)and 9.46％(14 cases/148 cases),there was no significant difference in the incidence of adverse reactions between the two groups(P＞0.05).Conclusion The treatment of neonatal hyperbilirubinemia with yeast burra combined with ursodeoxychonic acid can effectively improve the levels of serum γ-GT,IGF-1 and RBP,and the clinical efficacy is good.