Since 2021,the term"metaverse"has attracted wide attention and become an international hot word,meanwhile,the application of metaverse in the medical field has also attracted great attention.Because of its unique advantages such as the immersive environment,the integration of virtual-real space and the characteristics of super-high simulation,the metaverse have a broad application prospect in the medical field.At present,metaverse medicine has already been applied in the diagnosis and treatment of chronic diseases,psychological intervention,and innovative clinical teaching mode.With the increasing of innovations and applications of the technologies such as vascular interventional surgical robots,extended reality,3-D printing and others,the newly-developed metaverse medicine will be able to play an important role in facilitating interventional surgery and improving doctor training,although the application of metaverse medicine in endovascular interventional therapy is still in its developing stage now.It can be expected that with the gradual maturity of metaverse medicine,the remote-guided interventional surgeries,which can be accomplished with the help of technologies such as 5G,augmented reality(AR)and tactile internet,will become the normal work in medical practice,and,moreover,the simulation surgery training programs,which can be conducted with the help of technologies such as computer-assisted vascular intervention and virtual reality(VR),will also become the common pattern in medical teaching course.(J Intervent Radiol,2024,32:86-89)

Objective:To investigate the impact of daily step count on glycemic outcomes in community residents with impaired glucose tolerance (IGT).Methods:This was a prospective cohort study, in October 2018, 204 residents who met the criteria of IGT were recruited in the Shijingshan District in Beijing. The subjects were tested for fasting blood glucose, oral glucose tolerance test 2-hour blood glucose (2hBG), glycated hemoglobin A 1c (HbA 1c), lipid profile, liver and kidney function, as well as measurements of height, weight and waist circumference. A dedicated mobile application was used to deliver prediabetes health knowledge monthly. Online guidance was provided to answer questions and daily step count was collected using the application. Three years later, a follow-up was conducted to assess the participants′ glycemic outcomes and other indexes, and a total of 142 participants completed the follow-up review. According to daily step count, the subjects were categorized into high step count group (42 cases,>7 000 steps daily), moderate step count group (54 cases, 5 000-7 000 steps daily), and low step count group (46 cases,<5 000 steps daily). Subjects were categorized into diabetes group (30 cases), prediabetes group (77 cases) and normal glucose tolerance group (35 cases) with glycemic outcomes. Independent sample t test was used to compare the differences in blood glucose, blood lipids, and step counts between the two groups. Kruskal-Wallis H test or one-way ANOVA was used to compare the differences in blood glucose, blood lipids, and step counts between multiple groups. The χ2 test was used to compare the differences in glycemic outcomes between multiple groups. Multivariate logistic regression analysis was used to assess the impact of daily step counts and body mass index on glycemic outcomes. Linear regression analysis was used to evaluate the relationship between daily step counts and 2 h BG. Results:A total of 142 participants completed the 3-year follow-up, including 43 males and 99 females, with a mean age of (60.15±5.67) years. At baseline, males had significantly higher body mass index, waist circumference, and fasting blood glucose when compared to those in females [(26.97±2.43) vs (24.89±2.93) kg/m 2, (92.68±7.75) vs (83.83±8.60) cm, (5.83±0.61) vs (5.62±0.52) mmol/L], the total cholesterol and HDL-C were also significantly lower in males than those in females [(5.10±1.16) vs (5.55±0.95) mmol/L, (1.35±0.34) vs (1.56±0.35) mmol/L] (all P<0.05). After 3-year follow-up, 21.1% (30/142) of IGT participants progressed to diabetes, with an annual conversion rate of approximately 7%. The normal glucose tolerance group showed significantly higher daily step counts when compared with the prediabetes and diabetes groups [(7 886±2 867) vs (5 981±2 655) vs (4 117±2 674) steps] ( H=31.778, P<0.001). Individuals with higher daily step counts exhibited lower body mass index, 2 h BG, and HbA 1c level when compared with those in the ones with moderate and low step counts [(24.26±3.09) vs (25.44±3.38) vs (26.26±3.59) kg/m 2, (7.50±1.71) vs (9.15±3.30) vs (11.19±3.84) mmol/L, 5.97%±0.46% vs 6.14%±0.99% vs 6.40%±0.96%] (all P<0.05). Higher step count was positively correlated with the reversal of prediabetes to normal blood glucose levels (moderate step count, OR=0.297, 95% CI: 0.109-0.804; low step count, OR=0.055, 95% CI: 0.010-0.287), lower daily step count correlated positively with prediabetes progressing to diabetes ( OR=4.857, 95% CI: 1.140-20.689) (all P<0.05). For every additional 1 000 steps per day, the 2 h BG decreased by 0.5 mmol/L. Conclusion:As daily step count increases, the glucose metabolism improves in IGT community residents. Higher daily step count is associated with reversal of IGT to normal glucose tolerance, while lower daily step count may be associated with the progression of IGT to diabetes.

Objective:To investigate the effect of vancomycin (Vm)-loaded microbubbles (MBs) combined with ultrasound targeted microbubble destruction (UTMD) technique on the morphological structure, thickness and bacterial viability of methicillin-resistant Staphylococcus aureus (MRSA) biofilms.Methods:Vm-MBs were prepared by thin film hydration. Sterile coverslips in a diameter of 13 mm were placed in 24-well plates to construct in vitro biofilm models using MRSA as the test strain, and the biofilm morphology was observed by naked eye and light microscopy after crystal violet staining. LIVE/DEAD, SYTO59 and DIL were used to stain biofilms and MBs, respectively. After staining, the biofilm morphology and position of the biofilm in relation to MBs were observed using laser confocal scanning microscopy. The biofilms were divided into control group, Vm group, Vm-MBs group, UTMD group and Vm-MBs+UTMD group according to the random number table method, with 9 samples in each group. After biofilms of each group were treated accordingly for 24 hours, the morphological and structural changes of biofilms in each group were observed using laser confocal scanning microscopy and scanning electron microscopy following LIVE/DEAD staining; the difference in biofilm density in each group was measured with the aid of an enzyme marker following crystal violet staining; the difference in biofilm thickness and bacterial viability in each group were observed by laser confocal scanning microscopy. Results:The prepared Vm-MBs met the experimental requirements. The constructed biofilm model observed by naked eye, light microscopy and laser confocal scanning microscopy showed that the biofilm structure was dense with a relatively uniform thickness of (13.8±0.2)nm, a small amount of dead bacteria inside the membrane and the percentage of live bacteria of (94.9±0.3)%. Laser confocal scanning microscopy showed that MBs could penetrate into deeper layers of biofilms. After the respective treatment was given to each group for 24 hours, Laser confocal scanning microscopy and scanning electron microscopy following LIVE/DEAD staining showed that the biofilm morphological structure was most significantly disrupted in Vm-MBs+UTMD group compared to control, Vm, Vm-MBs and UTMD groups. In Vm-MBs+UTMD group, a large number of dead bacteria was observed, with only a few scattered planktonic bacteria and irregular changes in cell membrane morphology. Crystal violet staining showed that the biofilm density was significantly lower in Vm-MBs+UTMD group compared to control group ( P<0.05), while the differences between Vm, Vm-MBs and UTMD groups were not statistically significant (all P>0.05). Laser confocal microscopy showed that the biofilm thickness was thinner in Vm-MBs, UTMD and Vm-MBs+UTMD groups compared to control group (all P<0.05), with no significant difference between Vm group and control group ( P>0.05) and that the biofilm thickness was thinner in Vm-MBs+UTMD group compared to Vm, Vm-MBs and UTMD groups (all P<0.01), with no significant differences between the other groups (all P>0.05). Bacterial activity in Vm, Vm-MBs, UTMD and Vm-MBs+UTMD groups was significantly lower than that in control group (all P<0.01), with lower in Vm-MBs+UTMD group compared to Vm, Vm-MBs and UTMD groups (all P<0.01), but without significant difference between the other groups (all P>0.05). Conclusion:Vm-MBs combined with UTMD technology can effectively destroy the biofilm morphological structure to reduce biofilm thickness. Meanwhile, Vm-MBs combined with UTMD technology can release antibiotics and significantly decrease bacterial viability to improve antibiotic bactericidal efficacy.

Objective: To investigate the clinical effect of one-stage revision combined with intra-articular injection of antifungal agents in the treatment of chronic periprosthetic fungal infection. Methods: A retrospective analysis of 11 patients(4 hips, 7 knees) admitted with chronic periprosthetic fungal infection at Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University from January 2004 to April 2016.There were males and females with an age of 67 years (range:47-77 years). Each patient underwent single-stage revision including aggressive soft-tissue debridement. Liquid samples and tissue samples were immediately sent to the microbiology laboratory for drug sensitivity testing and histological analysis. Removed the infected components and cement thoroughly, pouring powdered vancomycin into the medullary cavity and direct intra-articular injection of fungussensitive antibiotics. The patients with infected hips received an uncemented prosthesis and 0.5 g of gentamicin loaded commercial cement was received by the patients with infected knee.After that, a new prosthesis was implanted.Long-term combination therapy of antibacterial agents and antifungal agents were given after operation. Recurrence of infection and clinical outcomes were evaluated. The follow-up period was 5 years (range: 2-12 years). Results: One patient died of acute heart failure on the eighth postoperative day.Three infection cases were recurred.Eight cases had satisfactory outcomes and required no additional surgical or medical treatment for recurrence of infection. The Harris hip score assessed preoperatively and at latest follow-up was increased from 39.25±5.12 to 79.50±4.79, the difference was statistically significant (t=-11.356, P=0.001).The Hospital for Special Surgery knee score was improved from preoperative 46.25±5.61 to final follow-up 80.50±5.06, and the difference was statistically significant (t=-9.930, P=0.002). Conclusion Treatment of chronic fungal periprosthetic joint infection with single-stage revision can be fairly effective for achieving acceptable functional outcomes.

Objective: To evaluate the mid-term outcomes of patients with chronic infected total hip arthroplasty (THA) after partial single-stage revision. Methods: From July 2000 to October 2013, a total of 31 patients (18 males and 13 females, mean age 54 years, mean BMI 24.7 kg/m²) with chronic infected THA underwent partial single-stage revision in our hospital were retrospectively analyzed in the present study. According to the fixation type and the material of the prosthesis, selective revision of the acetabular cup or femoral stem was performed by preoperative imaging and intraoperative evaluation. The characteristics of procedure included changing femoral head and liner components, aggressive soft tissue debridement, retention of the well-fixed femoral stem or acetabular cup, thorough exposed component brushing, adequate surgical area soaking by iodine and vancomycin powder used in medullary space. Pre- and post-operative outcomes were evaluated with the Harris hip score. The frequency of infection recurrence was recorded and the failure treatment of infection was defined as recurrence of infection in the same hip. Results: Acetabular cups were revised in 22 patients and femoral stems in nine patients. The average follow-up was 7.2±2.6 years (4.8-15.1 years). There were 4 (13%) failures during the study period at an average of 15 months (9-21 months) after partial single-stage revision. Two cases of them had grade A incision healing and another two cases had grade B incision healing. Of the 31 patients, a total of 27 (87%) patients had satisfactory outcomes with grade A incision healing and required no additional surgical or medical treatment for recurrence of infection. The Harris hip score was improved from 45.2±5.4 pre-operatively to 70.1±4.3 at one year post-operatively. The Harris hip score at 2 years and 5 years after surgery were 75.3±5.1 and 73.2±5.3, respectively. Conclusion In treating chronic infected THA, partial single-stage revision can be conducted fairly effective in eradication of infection and achieving acceptable functional outcomes while reducing surgical injury, which indicated that this is an attractive alternation in selected patients.

Objective To present clinical effects of debridement, antibiotics, irrigation and retention of implant (DAIR) with integrated antibiotics application in treating periprosthetic joint infection (PJI) occurred within 3 months after primary surgery. Methods We retrospectively analyzed patients who received DAIR between January 2011 and October 2015. A total of 49 pa?tients with a mean age of 62.38±14.56 years (range, 26-82 years) were included in this study, including 29 males and 20 females. There are 27 knees and 22 hips. Twenty?three patients has sinus tract. Failure was defined as subsequent surgical intervention for infection after the index procedure; persistent fistula, drainage, or excessive joint pain at the last follow?up; death related to the PJI; chronic suppression with antibiotics. Results There were 18 (36.7%) culture negative cases and 31 (63.3%) culture positive cases, including 28.6% (14/49) methicillin?sensitive staphylococcus aureus, 4% (2/49) methicillin?resistant staphylococcus aure?us, 2% (1/49) methicillin?resistant staphylococcus epidermidis, 2%(1/49) mixed infection with fungus and so on. Within the 68.34± 14.02 months (range, 39-94 months) follow?up duration, the Knee Society Score (KSS) score was improved from 38.37 ± 12.39 points (range, 18-62 points) pre?operatively to 82.26±10.50 points (range, 49-96 points) post?operatively (t=-17.09, P<0.001). KSS function score was improved from 42.19±10.14 points (range, 26-67 points) pre?operatively to 75.22±11.60 points (range, 41-90 points) post?operatively (t=-12.53, P<0.001). Harris hip score was improved from 47.41±8.39 points (range, 32-58 points) pre?operatively to 86.41±6.07 points (range, 71-96 points) post?operatively (t=-23.38, P<0.001). There were 6 patients receiving sub?sequent surgical intervention as failure. The mean duration from the index surgery to failure was 5.75±3.00 months (range, 1.5-10 months). Conclusion The present protocol of DAIR for dealing with early?stage PJI, which is less than 3 months after primary TKA or THA, is fairly effective.

Objective: To observe the outcomes of total hip arthroplasty in patients with stiff hip and moderate or severe leg length discrepancy and to explore the strategy for balance recovery. Methods: A retrospective review was conducted on the clinical data of 30 patients who had stiff hip and moderate or severe leg length discrepancy treated with unilateral primary total hip arthroplasty at Department of Joint Surgery, First Affiliated Hospital of Xinjiang Medical University from January 2014 to January 2017.There were 18 male and 12 female patients aging of (43.5±9.7)years (range, 30-68 years). All patients had different degrees of pelvic tilt and scoliosis. In operation, contractured soft tissues were released, periarticular osteophytes were removed thoroughly and the center of ratation was restablished without femoral shortening osteotomy.Patient satisfaction, Harris hip score, perceived leg length discrepancy (LLD), true LLD and functional LLD were collected.Data were analyzed by paired-samples t-test. Results: The mean follow-up duration was (17.6±7.6)months (range, 12-30 months). The Harris hip score was improved from 37.6±5.7 preoperatively to 84.3±5.2 at last follow-up (t=-57.54, P=0.000). The preoperative and last follow-up data of true LLD((3.19±0.82)cm vs.(0.70±0.71)cm), functional LLD((4.36±1.72)cm vs.(0.46±0.53)cm) and perceived LLD((7.74±2.01)cm vs.(0.98±0.79)cm) was significantly difference(t=26.47, t=15.05, t=26.9, P<0.01). Twenty-seven patients were restored to normal level (LLD≤10 mm ) and there was no sciatic nerve injury observed after surgery. 90.0% (27/30) patients were satisfied by the outcome. Conclusions Total hip arthroplasty have satisfactory effect in correcting leg-length discrepancy of stiff hip patients. Preoperative assessment, individualized surgical methods and soft tissue releasing are important for balance recovery of affected limbs.

Objective To investigatc thc short-term clinical and radiographic outcomes of tantalum trabecular metal (TM) components associated with TM augments for Paprosky type Ⅱ and type Ⅲ acetabular defects in revision hip arthroplasty.Methods From June 2014 to April 2016,seventeen patients with aseptic loosening underwent revision total hip arthroplasty for Paprosky type Ⅱ or type Ⅲ acetabular defects with TM revision acetabular cups and TM augments.The subjects consisted of 5 males and 12 females with mean age of 56.6 years (range 30-75).Acetabular bony defects were Paprosky type Ⅱ A in 4 hips,Ⅱ B in 3 hips,Ⅲ A in 8 and Ⅲ B in 2 hips.The whole hip revision was performed in 13 hips and acetabular reconstruction in 4 hips.Preand post-operative functional outcomes were accessed by the Harris Hip Score.The vertical and horizontal position of the rotation center from the intertear drop line were measured and analyzed.Complications were recorded during the follow-up.Radiographic examination was performed after operation immediately by X-ray.The recent X-ray was conducted to assess bone ingrowths at the cup-bone or augments-bone interface,radiolucent lines and implant migration.Results All of the patients were followed-up for an average of 23 months (range 11-33 months).There was no infection,dislocation or periprosthetic fracture complications at the last followed-up.The Harris Hip Score was improved from 45.8±3.4 pre-operatively to 79.2±7.5 post-operatively (t=-16.8,P=0.00).The mean vertical distance of the center of rotation was 32.1±4.3 mm preoperatively and 14.5±2.3 mm postoperatively (t=14.8,P=0.00).The mean horizontal distance of the center of rotation was 33.6±6.1 mm preoperatively and 27.8±3.2 mm postoperatively (t=3.5,P=0.00).More than 3 radiographic signs of osseointegration were observed in 11 hips.No progressive radiolucent lines or component migration was observed.All the TM components were well-fixed at last follow-up.Conclusion Using tantalum TM cups with TM augments in revision hip arthroplasty could be regarded as an effective management for Paprosky type Ⅱ and type Ⅲ acetabular defects.This technology can avoid using over-large cup,provide reliable primary stability,restore the center of rotation with almost normal hip biomechanics and improve the functional outcome.

Objective To investigate the short-term outcomes after revision hip arthroplasty for severe acetabular bone deficiency by cup-cage.Methods We retrospectively analyzed 16 patients (16 hips) with Paprosky type Ⅲ B acetabular bone deficiency,who received cup-cage from October 2013 to May 2016.There were 6 males and 10 females,with an average age of 62.6 years (range 40-84 years).All but one patient were with pelvic discontinuity.The reason for revision was aseptic loosening for 14 patients and periprosthetic joint infection for 2.Eleven patients underwent surgery via Trabecular Metal Acetabular Revision System (cup+cage),2 via Trabecular Metal cup and AR cage,and 3 via R3 cup and AR cage.During the follow-up,Harris hip score was recorded to evaluate the clinical efficacy,and X-rays were performed to identify the signs of loosening and changes in rotation center position.Results The mean follow-up was 18.7 months (range 6-36 months).The height of rotation center was decreased from 42.00±12.18 mm preoperatively to 22.75±8.44 mm postoperatively,whereas the horizontal distance of the rotation center was 26.81 ±7.61 mm preoperatively and 32.50±6.51 mm postoperatively (t=8.249,P＜0.001;t=-4.786,P＜0.001).The height of the rotation center was slightly higher than that of the contralateral side postoperatively (t=-3.478,P=0.003),whereas the difference in the horizontal distance of the rotation center between the two groups was not statistically significant (t=1.235,P=0.236).The Harris hip score was improved from 45.63± 11.68 preoperatively to 75.78±9.12 postoperatively (t=-12.157,P＜0.001).During the follow-up,one dislocation occurred at 5 days postoperatively and closed reduction was conducted under anesthesia.There was no blood vessel injury,nerve injury,wound complication and periprosthetic joint infection.No recurrence of infection occurred in 2 patients who received revision hip arthroplasty for periprosthetic joint infection.Conclusion Revision hip arthroplasty for Paprosky Ⅲ B acetabular bone deficiency by cup-cage can achieve good primary stability and reconstruct the rotation center,especially for patient with pelvic discontinuity.

BACKGROUND: Halofuginone has been proved to ameliorate the pathogenesis of osteoarthritis.OBJECTIVE: To further verify the protective effect of halofuginone on early osteoarthritis.METHODS: Forty-five healthy male C57BL6J mice were randomly divided into three groups (n=15 per group): the mice in sham operation group were only subjected to right knee capsulotomy; in the other two groups, animal models of osteoarthritis were established by cutting off the right anterior cruciate ligament, followed by treated with distilled water (placebo group) or 0.5 mg/kg halofuginone (halofuginone group) via gavage, once daily beginning at 3 days after modeling. Twenty-eight days after treatment, all mice were sacrificed and the right knee was removed. The morphology and structure of the joint tissue were observed by hematoxylin-eosin staining and safranin fast green staining; the expression of transforming growth factor-β1 (TGF-β1) was detected by immunohistochemistry.RESULTS AND CONCLUSION: The structure of articular cartilage in the sham operation group was normal, the cells arranged in neat rows, and the articular surface was not worn. In the placebo group, the articular cartilage layer became thinner, the cartilage surface was worn and even fragmented, and cells arranged in disorder. In the halofuginone group,the cartilage cell layer was clear and tidy, with regular cell morphology. The hyaline cartilage thickness and hyaline cartilage thickness/calcified cartilage thickness were ranked as follows: sham operation group > halofuginone group >placebo group. The calcified cartilage thickness was the highest in the placebo group, followed by halofuginone group,and lowest in the sham operation group. Osteoarthritis Research Society International scores and TGF-β1 positive cells/chondrocytes in the halofuginone group were significantly lower than those in the placebo group, and all above indices showed significant differences among groups (P < 0.05). These results suggest that halofuginone via gavage can partially prevent articular cartilage degeneration in early osteoarthritis mice probably by downregulating the expression of TGF-β1, thus delaying the progression of osteoarthritis.