Objective:To investigate the efficacy of hybrid fixation with tibial prosthesis in primary total knee arthroplasty (TKA) in patients with osteoporosis or osteopenia.Methods:A total of 39 patients (42 knees) with knee osteoarthritis who underwent primary TKA with hybrid fixation with tibial prosthesis in the First Affiliated Hospital of Zhejiang University from November 2022 to June 2024 were retrospectively analyzed. There were 12 males and 27 females with an average age of 68.23±7.02 years (range, 58-89 years). The mean body mass index was 26.15±4.63 kg/m 2 (range, 19.48-39.03 kg/m 2), and the mean bone mineral density T score was -2.38±0.78 (from -4.2 to -1.2). The left knee was 19, and the right knee was 23. The visual analogue scale (VAS) and Knee Society score (KSS) were used to evaluate the knee joint pain and function, and the knee flexion range of motion was measured. Radiographic evaluation included hip-knee-ankle angle, lateral distal femoral angle, and posterior slope of tibial plateau. Results:All patients successfully completed the operation and were followed up for 19.8±5.1 months (range, 4.9-23.6 months). All patients were treated with hybrid fixation with tibial prosthesis assisted by 3D printed porous titanium alloy sleeve. The operation time was 73.8±10.8 min (range, 54-98 min). Thirty-four of 39 patients received standard anti-osteoporosis therapy before operation. The VAS score at the last follow-up was 0(0, 1), which was lower than that before operation 7(6,8), and the difference was statistically significant ( U<0.001, Ρ<0.001). The KSS clinical score at the last follow-up was 76.67±10.04, which was higher than that before operation (50.95±7.35), and the difference was statistically significant ( t=12.030, Ρ<0.001). The knee flexion range of motion at last follow-up was 97.26°±12.94°, showing no significant difference when compared with preoperative 94.52°±16.52° ( t=0.846, Ρ=0.400). The hip-knee-ankle angle at last follow-up was 176.2°±2.54°, which was significantly higher than that before operation 173.5°±5.25° ( t=3.328, Ρ=0.002). The distal lateral femoral and posterior tibial inclination angles at the final follow-up were 89.58°±1.62° and 2.85°±0.91°, respectively, compared with 90.71°±4.01° and 3.05°±1.25° preoperatively, with no statistically significant differences ( t=1.556, Ρ=0.127; t=0.923, Ρ=0.359). No prosthesis loosening, dislocation, periprosthetic infection, deep vein thrombosis and other complications occurred. Conclusion:Hybrid fixation with tibial prosthesis in primary TKA for patients with osteoporosis or osteopenia has a satisfactory clinical effect, which can relieve knee pain and improve joint function.

Objective:To investigate the efficacy of hybrid fixation with tibial prosthesis in primary total knee arthroplasty (TKA) in patients with osteoporosis or osteopenia.Methods:A total of 39 patients (42 knees) with knee osteoarthritis who underwent primary TKA with hybrid fixation with tibial prosthesis in the First Affiliated Hospital of Zhejiang University from November 2022 to June 2024 were retrospectively analyzed. There were 12 males and 27 females with an average age of 68.23±7.02 years (range, 58-89 years). The mean body mass index was 26.15±4.63 kg/m 2 (range, 19.48-39.03 kg/m 2), and the mean bone mineral density T score was -2.38±0.78 (from -4.2 to -1.2). The left knee was 19, and the right knee was 23. The visual analogue scale (VAS) and Knee Society score (KSS) were used to evaluate the knee joint pain and function, and the knee flexion range of motion was measured. Radiographic evaluation included hip-knee-ankle angle, lateral distal femoral angle, and posterior slope of tibial plateau. Results:All patients successfully completed the operation and were followed up for 19.8±5.1 months (range, 4.9-23.6 months). All patients were treated with hybrid fixation with tibial prosthesis assisted by 3D printed porous titanium alloy sleeve. The operation time was 73.8±10.8 min (range, 54-98 min). Thirty-four of 39 patients received standard anti-osteoporosis therapy before operation. The VAS score at the last follow-up was 0(0, 1), which was lower than that before operation 7(6,8), and the difference was statistically significant ( U<0.001, Ρ<0.001). The KSS clinical score at the last follow-up was 76.67±10.04, which was higher than that before operation (50.95±7.35), and the difference was statistically significant ( t=12.030, Ρ<0.001). The knee flexion range of motion at last follow-up was 97.26°±12.94°, showing no significant difference when compared with preoperative 94.52°±16.52° ( t=0.846, Ρ=0.400). The hip-knee-ankle angle at last follow-up was 176.2°±2.54°, which was significantly higher than that before operation 173.5°±5.25° ( t=3.328, Ρ=0.002). The distal lateral femoral and posterior tibial inclination angles at the final follow-up were 89.58°±1.62° and 2.85°±0.91°, respectively, compared with 90.71°±4.01° and 3.05°±1.25° preoperatively, with no statistically significant differences ( t=1.556, Ρ=0.127; t=0.923, Ρ=0.359). No prosthesis loosening, dislocation, periprosthetic infection, deep vein thrombosis and other complications occurred. Conclusion:Hybrid fixation with tibial prosthesis in primary TKA for patients with osteoporosis or osteopenia has a satisfactory clinical effect, which can relieve knee pain and improve joint function.

Objective:To explore the early effects and safety of using a hybrid fixation strategy with 3D-printed porous tantalum metal augments to reconstruct substantial bone defects in complex primary total knee arthroplasty (TKA).Methods:A retrospective analysis was performed on the clinical data from August 2019 to September 2023, encompassing 20 patients (21 knees) with significant bone loss who underwent hybrid fixation with 3D-printed porous tantalum augments. The procedures were conducted at two medical centers: the First Affiliated Hospital, School of Medicine, Zhejiang University (11 cases) and Xiangya Hospital of Central South University (9 cases). The study cohort comprised 6 males (6 knees) and 14 females (15 knees), with a mean age of 61.05±11.23 years (range, 42-80 years). The distribution of cases was 7 on the left side and 14 on the right side. All cases were categorized as type 3 according to the Anderson Orthopaedic Research Institute (AORI) classification system. The cohort included 19 unilateral and 1 bilateral case, with 5 involving complex primary replacements (3 with Charcot arthropathy, 1 with syphilitic arthropathy, and 1 with severe valgus deformity) and 16 revision surgeries (13 for aseptic loosening and 3 for infection). Preoperative assessments included routine CT scans and digital three-dimensional reconstructions to identify large metaphyseal defects exceeding 50% of the metaphyseal area or those thicker than 10 mm. For such defects, 3D-printed standardized porous tantalum augments were implemented. In cases of extensive cavitary bone defects or severe metaphyseal defects where the medial and lateral defects collectively exceeded 80% of the metaphyseal region or where the residual bone stock was insufficient for screw fixation of standardized augments, 3D-printed personalized custom-made porous tantalum augments were employed for hybrid fixation and repair. Comparative analyses were conducted on pre- and postoperative imaging data (prosthesis positioning and complications), knee range of motion (ROM), visual analogue scale (VAS) for pain, and Knee Society score (KSS).Results:Of the cases, 17 were repaired using standardized 3D-printed porous tantalum augments, while 4 underwent repairs with customized augments for hybrid fixation. Follow-up averaged 26.5±15.0 months (range, 12-62 months). There was a significant increase in knee ROM, improving from 72.8°±31.9° preoperatively to 113.2°±6.8° at 12 months postoperatively ( P<0.05). VAS scores decreased from 6.6±1.4 preoperatively to 2.5±1.0 at 12 months postoperatively ( P<0.05). Similarly, KSS improved from 52.8±6.4 preoperatively to 80.7±7.9 at 12 months postoperatively ( P<0.05). There were no incidences of prosthesis displacement, poor bone integration, or postoperative infections. Conclusion:The hybrid fixation strategy employing 3D-printed porous tantalum augments has been found to be effective in addressing significant bone defects in TKA. The follow-up results indicate a satisfactory biological integration of the porous tantalum metal augments with the host bone, which has resulted in substantial improvements in pain relief and knee joint functionality.

Objective:To investigate the effect of different assisted reproductive technologies (ART) and transplanted embryos at different developmental stages on live birth sex ratio in frozen-thawed embryo transfer (FET) cycles.Methods:From April 2010 to October 2018, the clinical data of patients and neonatal underwent in vitro fertilization-frozen-thawed embryo transfer (IVF-FET), intracytoplasmic sperm injection-frozen-thawed embryo transfer (ICSI-FET) and preimplantation genetic testing-frozen-thawed embryo transfer (PGT-FET) cycles that led to birth in the Center of Reproductive Medicine, Guangzhou Women and Children's Medical Center were retrospectively analyzed. The relationship of the sex ratio of the live births to different ART and transplanted embryos at different developmental stages was studied. Results:1) IVF-FET cycles included 898 couples (920 FET cycles) and 1166 babies, with a general sex ratio of 106.7. The live birth sex ratio increased gradually at pre-morula stage, morula stage and blastocyst stage embryo transfer (99.0, 135.4, 142.6), but no statistical difference was observed between the groups ( P>0.05). 2) ICSI-FET cycles included 415 couples (433 FET cycles) and 555 babies, with a general live birth sex ratio of 111.0. After the transfer of embyos at different stages the proportion of male babies displayed no significant difference ( P>0.05). 3) PGT-FET cycles included 33 couples (33 FET cycles) and 33 babies, with a general live birth sex ratio of 153.8. Transplantation of blastocysts in IVF, ICSI or PGT had no significant effect on the proportion of male babies ( P>0.05). Conclusion:In FET cycles, compared with embryo transfer at early stage, late stage embryo transfer may be associated with a higher live birth sex ratio. The transfer of ICSI-FET embryos at different developmental stages and the transfer of blastocysts by IVF, ICSI or PGT technique did not affect the sex ratio of live birth.

Objective:To investigate the effect of different assisted reproductive technologies (ART) and transplanted embryos at different developmental stages on live birth sex ratio in frozen-thawed embryo transfer (FET) cycles.Methods:From April 2010 to October 2018, the clinical data of patients and neonatal underwent in vitro fertilization-frozen-thawed embryo transfer (IVF-FET), intracytoplasmic sperm injection-frozen-thawed embryo transfer (ICSI-FET) and preimplantation genetic testing-frozen-thawed embryo transfer (PGT-FET) cycles that led to birth in the Center of Reproductive Medicine, Guangzhou Women and Children's Medical Center were retrospectively analyzed. The relationship of the sex ratio of the live births to different ART and transplanted embryos at different developmental stages was studied. Results:1) IVF-FET cycles included 898 couples (920 FET cycles) and 1166 babies, with a general sex ratio of 106.7. The live birth sex ratio increased gradually at pre-morula stage, morula stage and blastocyst stage embryo transfer (99.0, 135.4, 142.6), but no statistical difference was observed between the groups ( P>0.05). 2) ICSI-FET cycles included 415 couples (433 FET cycles) and 555 babies, with a general live birth sex ratio of 111.0. After the transfer of embyos at different stages the proportion of male babies displayed no significant difference ( P>0.05). 3) PGT-FET cycles included 33 couples (33 FET cycles) and 33 babies, with a general live birth sex ratio of 153.8. Transplantation of blastocysts in IVF, ICSI or PGT had no significant effect on the proportion of male babies ( P>0.05). Conclusion:In FET cycles, compared with embryo transfer at early stage, late stage embryo transfer may be associated with a higher live birth sex ratio. The transfer of ICSI-FET embryos at different developmental stages and the transfer of blastocysts by IVF, ICSI or PGT technique did not affect the sex ratio of live birth.

One of the great challenges in assisted reproduction today is the management of cases with poor-quality oocytes. Ooplasmic transfer (OT) has been used with the aim of augmenting embryo viability in patients with multiple implantation failures, usually associated with developmentally compromised oocytes. The justification for the technique was that the ooplasm from the donor contained beneficial components lacking in the recipient's oocytes, and that the transfer of these components to the recipient's oocytes would result in normal growth and viability. This review focuses on concerns regarding its use in assisted reproduction, like mitochondrial functioning, mitochondrial DNA heteroplasmy, regulation of apoptosis, cleavage division, epigenetic modifications, oocyte contents and mRNA which are the factors affecting oocytes due to mixing of two entities. The applications, efficacy and adverse effects of OT techniques in human are summarized.

One of the great challenges in assisted reproduction today is the management of cases with poor-quality oocytes. Ooplasmic transfer (OT) has been used with the aim of augmenting embryo viability in patients with multiple implantation failures, usually associated with developmentally compromised oocytes. The justification for the technique was that the ooplasm from the donor contained beneficial components lacking in the recipient's oocytes, and that the transfer of these components to the recipient's oocytes would result in normal growth and viability. This review focuses on concerns regarding its use in assisted reproduction, like mitochondrial functioning, mitochondrial DNA heteroplasmy, regulation of apoptosis, cleavage division, epigenetic modifications, oocyte contents and mRNA which are the factors affecting oocytes due to mixing of two entities. The applications, efficacy and adverse effects of OT techniques in human are summarized.

Objective: To investigate the effects of dexmedetomidine (DEX) on oxidative stress and systemic inflammatory response syndrome(SIRS) during cardiopulmonary bypass (CPB).Methods: Totally 62 patients scheduled for mitral valve replacement surgery were enrolled in this study and randomly assigned to DEX group with constant infusion of DEX (0.5 μg·kg-1 ·h-1 , n =31) and the control group with the same amount of 0.9% sodium chloride injection(n =31).A volume of 4 ml of jugular vein blood was respectively withdrawn before the induction of anesthesia (T0), at 10 min after aortic-off clamping(T1), the end of bypass(T2), 4h after bypass(T3),12h after bypass(T4) and 24h after bypass(T5).The serum C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), interleukin-6(IL-6), interleukin-8(IL-8) and interleukin-10(IL-10) were determined.Results: The serum CRP in both groups increased remarkably at T1-T5 , while the serum CRP in DEX group was significantly lower than those in the control group at T3-T5.The serum TNF-α increased remarkably in control group at T2-T4, while the serum TNF-α increased remarkably in DEX group at T2-T3;the serum TNF-α in DEX group was significantly lower than those in the control group at T3-T4.The serum IL-6, IL-8, IL-10 in both groups were increased remarkably at T2-T5, T1-T5,T1-T3, respectively.The serum IL-6 and IL-8 in the DEX group were significantly lower than those in the control group at T2-T4 while the serum IL-10 in the DEX group was significantly higher than that in the control group at T1-T3.The serum WBC in both groups at T3-T5 were higher than those at T0, while the serum WBC in the control group was significantly higher than that in the DEX group at T3-T5.However, the differences between the two groups at mechanical ventilation time, ICU observation time, the incidence of postoperative SIRS after 24h, hospitalization days, and the adverse reactions were not statistically significant.Conclusion: DEX has notable protective effects on systemic inflammatory response syndrome during extracorporeal circulation.

Objective To evaluate the prevalence and risk factors of progressive liver fibrosis in patients with non-alcoholic fatty liver disease (NAFLD).Methods A total of 2 054 subjects who underwent health check up and were diagnosed as NAFLD in 9 institutions were included in the study.Blood routine and biochemical findings were collected to calculate aspartate aminotransferase-to-platelet ratio index (APRI).Subjects were divided into three groups according to diagnostic threshold of liver fibrosis:APRI ＜0.43 group,APRI 0.43-0.53 group and APRI ≥ 0.54 group.The correlation between APRI and biochemical variables was analyzed,and the risk factors of progressive fibrosis were also analyzed.Results Among 2 054 subjects (male/female 1 598/456) there were 61 cases with APRI ≥ 0.98 (2.97％,progressive fibrosis),318 with APRI ≥0.54 (15.48％),1 475 with APRI ＜ 0.43 (71.81％),261 with APRI 0.43-0.53 (12.71％).Logistic stepwise regression analysis showed that TG (P =0.002,OR =1.095,95％CI:1.033-1.161),2 hPG(P =0.000,OR =1.103,95％ CI:1.058-1.151,BUN(P =0.034,OR =1.215,95 ％ CI:1.014-1.454) were risk factors,and H DL-C (P =0.034,OR =0.353,95 ％ CI:O.135-0.924) was a protective factor for the progression of fibrosis.Conclusion The progressive fibrosis in patients with NAFLD is closely associated to blood glucose and lipid metabolism disorder.

Objective To compare the changes of four flavonoid glycosides in the leaves of Hippophae rhamnoides L . before and after fermentation .Methods The water extract of Hippophae rhamnoides L .leaves and its fermented tea were con-centrated and desiccated .The dry extracts were dissolved in 70％ ethanol .The chromatographic separation was performed with RP-HPLC method on an Extend-C18 column (4 .6 mm × 250 mm ,5 μm) .Acetonitrile-0 .1％ formic acid was selected as mobile phase at the flow rate of 1 .0 ml/min .The detection wavelength was 356 nm and the column temperature was 30 ℃ .Results The rutin content was high in the leaves of Hippophae rhamnoides L .After fermentation ,isoquercitrin content was increased , while the contents of rutin and narcissoside were reduced and isorhamnetin-3-O-glucoside stayed unchanged .There was a good linear relationship between the concentration and peak areas of the four compounds (r>0 .9997) .The average recoveries were between 96％-103％ .Conclusion This established method is rapid and reliable ,which can be used for the quality control of Hippophae rhamnoides L .leaves and its fermented tea .