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Addressing metallosis in knee arthroplasty:From diagnostic challenges to innovative treatments

World Journal of orthopedics 2024年第5期15卷 386-389页

作者： Yvon Maurice Bogdonoff Farid Amirouche Department of Orthopedics Surgery University of Illinois at ChicagoChicagoIL 60612United States Department of Orthopedics Surgery Northshore University Health SystemSkokieIL 60076United States

In this editorial,we comment on the article by Toro et al published in the recent issue of World Journal of orthopedics.This editorial review provides a comprehensive exploration of the landscape surrounding knee arthroplasty metallosis,focusing on key aspects ranging from the mechanisms influencing susceptibility to clinical implications and advanced treatment strategies.We elucidate the complex interplay of implant design,patient-specific variables,and wear-related processes contributing to metallosis.Furthermore,we seek to shed light on diagnostic challenges,the necessity of a multidisciplinary approach,and the imperative for vigilant implant surveillance.Uni-on-uni revision,as a targeted treatment modality,is discussed,highlighting its potential to address metallosis in unicompartmental knee arthroplasty(UKA).There is a need for heightened awareness among clinicians regarding the subtle presentations of metallosis,coupled with the limitations of traditional imaging techniques.Addressing metallosis requires a collaborative,multidisciplinary approach to effectively navigate the complexities associated with this complication.Furthermore,the review emphasizes the evolving paradigm of personalized care,with uni-on-uni revision emerging as a promising surgical solution.In conclusion,the editorial outlines the dynamic nature of knee arthroplasty metallosis and its multifaceted impact on clinical practice.It calls for ongoing collaboration,education,and integration of innovative solutions to enhance diagnostic accuracy,proactive management,and overall patient outcomes in the realm of UKA.

关键词： Ultrasound X-ray Total knee arthroplasty Case report Review Editorial

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Mechanisms of hyponatremia and diabetes insipidus after acute spinal cord injury:a critical review

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Chinese Neurosurgical Journal 2024年第1期10卷 42-47页

作者： Lianhua Li Yanhui Guo Chen Chen Zhonghe Wang Zhi Liu Department of Orthopedics the Fourth Medical Center of PLA General HospitalBeijingChina

The incidence of hyponatremia after spinal cord injury was reported to be between 25 and 80%.Hyponatremia can lead to a variety of clinical symptoms,from mild to severe and even life-threatening.Hyponatremia is often associated with diabetes insipidus,which refers to insufficient arginine vasopressin(AVP)secretion or defective renal response to AVP,with clinical manifestations of syndromes such as hypoosmolality,polydipsia,and polydipsia.Recent mechanistic studies on hyponatremia and diabetes insipidus after acute spinal cord injury have been performed in isolation,without integrating the above two symptoms into different pathological manifestations that occur in the same injury state and without considering the acute spinal cord injury patient’s condition as a whole.The therapeutic principles of CSWS and SIADH are in opposition to one another.It is not easy to identify the mechanism of hyponatremia in clinical practice,which makes selecting the treatment difficult.According to the existing theories,treatments for hyponatremia and diabetes insipidus together are contraindicated,whether the mechanism of hyponatremia is thought to be CSWS or SIADH.In this paper,we review the mechanism of these two pathological manifestations and suggest that our current understanding of the mechanisms of hyponatremia and diabetes insipidus after high acute cervical SCI is insufficient,and it is likely that there are other undetected pathogenetic mechanisms.

关键词： Mechanism Hyponatremia Diabetes insipidus Spinal cord injury

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Management of Lisfranc injury with anterolateral calcaneal compression fracture

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Chinese Medical Journal 2022年第6期135卷 727-729页

作者： Wenqi Gu Rui Zhang Wanjun Liu Zhongmin Shi Guohua Mei Jianfeng Xue Jian Zou Xiaokang Wang Jiantao Jiang Department of Orthopedics Shanghai Jiaotong University Affiliated Sixth People's HospitalShanghai 200233China Department of Orthopedics The People's Hospital of Ludian CountyLudianYunnan 657100China

To the Editor:The mechanism of Lisfranc injury is complex and may cause different patterns of fractures or dislocation of the midfoot complex.Abduction force injury is a special injury pattern,which may cause the fracture or(and)dislocation of the lateral column of the Lisfranc joint,especially the cuboid.[1,2,3]However,the anterolateral calcaneus is less commonly involved.Since the fragment of the calcaneocuboid(CC)joint facet is too uncon-spicuous to manifest on a plain X-ray,and surgeons always pay more attention to the Lisfranc joint,anterolateral calcaneal compression fracture and even Chopart joint injuries are often overlooked,which may lead to a delayed surgical management,chronic foot deformities,and functional disability.

关键词： fracture dislocation injuries

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Ferroptosis inhibition protects vascular endothelial cells and maintains integrity of the blood-spinal cord barrier after spinal cord injury

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Neural Regeneration Research 2023年第11期18卷 2474-2481页

作者： Wenxiang Li Xiaoqing Zhao Rong Zhang Xinjie Liu Zhangyang Qi Yang Zhang Weiqi Yang Yilin Pang Chenxi Zhao Baoyou Fan Ning Ran Jiawei Zhang Xiaohong Kong Shiqing Feng Xue Yao Shandong University Center for orthopedics Department of OrthopedicsQilu Hospital of Shandong UniversityCheeloo College of MedicineShandong UniversityJinanShandong ProvinceChina Tianjin Key Laboratory of Spine and Spinal Cord National Spinal Cord Injury International Cooperation BaseDepartment of OrthopedicsTianjin Medical University General HospitalTianjinChina

Maintaining the integrity of the blood-spinal cord barrier is critical for the recove ry of spinal cord injury.Ferro ptosis contributes to the pathogenesis of spinal cord injury.We hypothesized that ferroptosis is involved in disruption of the blood-s pinal cord barrier.In this study,we administe red the ferroptosis inhibitor liproxstatin-1 intraperitoneally after contusive spinal co rd injury in rats.Liproxstatin-1 improved locomotor recovery and somatosensory evoked potential electrophysiological performance after spinal cord inju ry.Liproxstatin-1 maintained blood-spinal cord barrier integrity by upregulation of the expression of tight junction protein.Liproxstatin-1 inhibited ferroptosis of endothelial cell after spinal cord injury,as shown by the immunofluorescence of an endothelial cell marker(rat endothelium cell antigen-1,RECA-1) and fe rroptosis markers Acyl-CoA synthetase long-chain family member 4 and 15-lipoxygenase.Liproxstatin-1reduced brain endothelial cell ferroptosis in vitro by upregulating glutathione peroxidase 4 and downregulating Acyl-CoA synthetase long-chain family member4 and 15-lipoxygenase.Furthermore,inflammatory cell recruitment and astrogliosis were mitigated after liproxstatin-1 treatment.In summary,liproxstatin-1im proved spinal cord injury recovery by inhibiting ferroptosis in endothelial cells and maintaining blood-s pinal co rd barrier integrity.

关键词： blood-spinal cord barrier ferroptosis liproxstatin-1 neuroinflammation spinal cord injury vascular endothelial cells

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Chitin scaffold combined with autologous small nerve repairs sciatic nerve defects

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Neural Regeneration Research 2022年第5期17卷 1106-1114页

作者： Bo Wang Chang-Feng Lu Zhong-Yang Liu Shuai Han Pi Wei Dian-Ying Zhang Yu-Hui Kou Bao-Guo Jiang Department of Orthopedics and Trauma Key Laboratory of Trauma and Neural Regeneration(Ministry of Education/Peking University)Peking University People’s HospitalBeijingChina Department of Orthopedics Chinese PLA General HospitalBeijingChina National Clinical Research Center for orthopedics Sports Medicine&RehabilitationBeijingChina

Although autologous nerve transplantation is the gold standard for treating peripheral nerve defects,it has many clinical limitations.As an alternative,various tissue-engineered nerve grafts have been developed to substitute for autologous nerves.In this study,a novel nerve graft composed of chitin scaffolds and a small autologous nerve was used to repair sciatic nerve defects in rats.The novel nerve graft greatly facilitated regeneration of the sciatic nerve and myelin sheath,reduced atrophy of the target muscle,and effectively restored neurological function.When the epineurium of the small autogenous nerve was removed,the degree of nerve regeneration was similar to that which occurs after autogenous nerve transplantation.These findings suggest that our novel nerve graft might eventually be a new option for the construction of tissue-engineered nerve scaffolds.The study was approved by the Research Ethics Committee of Peking University People's Hospital(approval No.2019 PHE27)on October 18,2019.

关键词： autologous small nerve chitin scaffold nerve defect nervous system peripheral nerve injury peripheral nerve regeneration sciatic nerve trauma

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Operative management of a shear fracture of the bilateral capitellum： A case report and review of the literature

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Chinese Journal of Traumatology 2016年第4期19卷 231-234页

作者： Alessandro Are Ignazio Tornatore Emmanouil Theodorakis Department of Orthopedics Policlinico Casilino Hospital Rome Italy Department of Orthopedics Aurelia Hospital Rome Italy

Fracture of bilateral capitulum humeri is a very rare injury. We present a case of a 38-year-old woman, affected by a shear fracture of bilateral capitellum after a motorcycle accident. Intervention was carried out through a lateral approach on both sides and direct fixation of the fragment with headless screws. Consolidation was achieved and no signs of avascular necrosis occurred at 24months of follow-up. The patient returned to her previous activities with no functional limitations. To the best of our knowledge, only four cases are reported describing different types of treatment and postoperative period of cast immobilization. According to our review of the literature regarding capitellar fractures, we preferred an immediate postoperative rehabilitation of the elbow, following the stable osteosynthesis.

关键词： Elbow joint Fracture of capitulum humeri Fracture fixation Internal Recovery of functional

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M1-type microglia can induce astrocytes to deposit chondroitin sulfate proteoglycan after spinal cord injury

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Neural Regeneration Research 2022年第5期17卷 1072-1079页

作者： Shui-Sheng Yu Zi-Yu Li Xin-Zhong Xu Fei Yao Yang Luo Yan-Chang Liu Li Cheng Mei-Ge Zheng Jue-Hua Jing Department of Orthopedics The Second Hospital of Anhui Medical UniversityHefeiAnhui ProvinceChina

After spinal cord injury(SCI),astrocytes gradually migrate to and surround the lesion,depositing chondroitin sulfate proteoglycan-rich extracellular matrix and forming astrocytic scar,which limits the spread of inflammation but hinders axon regeneration.Meanwhile,microglia gradually accumulate at the lesion border to form microglial scar and can polarize to generate a pro-inflammatory M1 phenotype or an anti-inflammatory M2 phenotype.However,the effect of microglia polarization on astrocytes is unclear.Here,we found that both microglia(CX3 CR1^(+))and astrocytes(GFAP^(+))gathered at the lesion border at 14 days post-injury(dpi).The microglia accumulated along the inner border of and in direct contact with the astrocytes.M1-type microglia(i NOS^(+)CX3 CR1^(+))were primarily observed at 3 and 7 dpi,while M2-type microglia(Arg1^(+)CX3 CR1^(+))were present at larger numbers at 7 and 14 dpi.Transforming growth factor-β1(TGFβ1)was highly expressed in M1 microglia in vitro,consistent with strong expression of TGFβ1 by microglia in vivo at 3 and 7 dpi,when they primarily exhibited an M1 phenotype.Furthermore,conditioned media from M1-type microglia induced astrocytes to secrete chondroitin sulfate proteoglycan in vitro.This effect was eliminated by knocking down sex-determining region Y-box 9(SOX9)in astrocytes and could not be reversed by treatment with TGFβ1.Taken together,our results suggest that microglia undergo M1 polarization and express high levels of TGFβ1 at 3 and 7 dpi,and that M1-type microglia induce astrocytes to deposit chondroitin sulfate proteoglycan via the TGFβ1/SOX9 pathway.The study was approved by the Institutional Animal Care and Use Committee of Anhui Medical University,China(approval No.LLSC20160052)on March 1,2016.

关键词： astrocytes astrocytic scar chondroitin sulfate proteoglycan M1/M2 polarization microglia sex-determining region Y-box 9 spinal cord injury transforming growth factor-β1

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Combined anterior and posterior ring fixation versus posterior ring fixation alone in the management of unstable Tile B and C pelvic ring injuries:A randomized controlled trial

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Chinese Journal of Traumatology 2023年第1期26卷 48-59页

作者： Islam Sayed Moussa Ahmed Mohammed Sallam Amr Khairy Mahmoud Elzaher Hassan Elzaher Amr Mohammed Nagy Ahmed Salem Eid Department of Orthopedics and Traumatology Faculty of MedicineAin Shams UniversityCairo11522Egypt

Purpose: Combined anterior and posterior ring (APR) fixation is classically performed in Tile B2 and C1 injuries to achieve superior biomechanical stability.However,the posterior ring (PR) is the main weight bearing portion that is responsible for weight transmission from the upper parts of the body to the lower limbs through the sacrum and the linea terminalis.It is hypothesized that isolated PR fixation can achieve comparable radiological and clinical outcomes to APR fixation.Therefore,we conducted this study to compare the two fixation principles in managing Tile B2 and C1 injuries.Methods: Our study included 20 patients with Tile B2 injuries and 20 patients with Tile C1 injuries.This study was a randomized control single-blinded study via computerized random numbers with a 1:1 allocation by using random block method.The study was performed at a level one trauma center.A total of 40 patients with Tile B2 and C1 injuries underwent combined APR or isolated PR fixation (Group A and B,respectively).Matta & Tornetta radiological principles and Majeed pelvic scoring system were used for the assessment of primary outcomes and postoperative complications.Secondary outcomes included operative time,amount of blood loss,intraoperative assessment of reduction,need of another operation,length of hospital stay,ability to weight bear postoperatively and pain control metrics.We used studentt-test to compare the difference in means between two groups,and Chi-square test to compare proportions between two qualitative parameters.We set the confidence interval to 95% and the margin of error accepted to 5%.So,p ≤ 0.05 was considered statistically significant.Results: The mean follow-up duration was 18 months.The operative time (mean difference 0.575 h) and the intraoperative blood loss (mean difference 97.5 mL) were lower in Group B.Also,despite the higher frequency of rami displacement before union in the same group,there were no significant differences in terms of radiological outcome (excellent outcome withOR = 2.357),clinical

关键词： Tile B2 and C1 injuries Percutaneous sacroiliac screw Posterior ring fixation Radiological outcome Majeed pelvic score

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Metal ion metabolism and osteoporosis: possible implications for pharmaceutical biotechnology and tissue engineering

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Science China Life Sciences 2024年

作者： Huaqiang Tao Qiufei Wang Kai Chen Pengfei Zhu Ye Gu Dechun Geng Department of Orthopedics Hai'an People's Hospital Department of Orthopedics The First Affiliated Hospital of Soochow University Department of Orthopedics Changshu Hospital Affiliated to Soochow University First People's Hospital of Changshu City

Osteoporosis (OP) is a systemic metabolic bone disease characterized by low bone mass, damage to bone microstructure and increased bone fragility. The imbalance of functional coupling between osteoblasts and osteoclasts contributes to the pathological progression of the disease (Rachner et al., 2011). The pathogenesis of OP is precisely controlled by the complex regulatory network of the bone microenvironment. Metallic elements, although present in small amounts in the body, are essential for their influence on the physiological activities of cells.

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Down-regulating Circular RNA Prkcsh suppresses the inflammatory response after spinal cord injury

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Neural Regeneration Research 2022年第1期17卷 144-151页

作者： Jia-Nan Chen Yi-Ning Zhang Li-Ge Tian Ying Zhang Xin-Yu Li Bin Ning Department of Orthopedics Jinan Central HospitalCheeloo College of MedicineShandong UniversityJinanShandong ProvinceChina Department of Orthopedics Central Hospital Affiliated to Shandong First Medical UniversityJinanShandong ProvinceChina

Circular RNAs(circRNAs)are a class of conserved,endogenous non-coding RNAs that are involved in transcriptional and post-transcriptional gene regulation and are highly enriched in the nervous system.They participate in the survival and differentiation of multiple nerve cells,and may even promote the recovery of neurological function after stroke.However,their role in the inflammatory response after spinal cord injury remains unclear.In the present study,we established a mouse model of T9 spinal cord injury using the modified Allen’s impact method,and identified 16,013 circRNAs and 960 miRNAs that were differentially expressed after spinal cord injury.Of these,the expression levels of circPrkcsh were significantly different between injured and sham-treated mice.We then treated astrocytes with tumor necrosis factor-αin vitro to simulate the inflammatory response after spinal cord injury.Our results revealed an elevated expression of circPrkcsh with a concurrent decrease in miR-488 expression in injured cells.We also found that circPrkcsh regulated the expression of the inflammationrelated gene Ccl2.Furthermore,in tumor necrosis factor-α-treated astrocytes,circPrkcsh knockdown decreased the expression of Ccl2 by upregulating miR-488 expression,and reduced the secretion of inflammatory cytokines in vitro.These findings suggest that differentially expressed circRNAs participate in the inflammatory response after spinal cord injury and act as the regulators of certain microRNAs.Furthermore,circPrkcsh may be used as an miR-488 sponge to regulate Ccl2 expression,which might provide a new potential therapy for SCI.The study was approved by the Animal Ethics Committee of Shandong University of China(approval No.KYLL-20170303)on March 3,2017.

关键词： astrocyte Ccl2 ceRNA circRNA inflammation miR-488 ncRNA Prkcsh RNA sequencing spinal cord injury

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