Primary cilia as a novel horizon between neuron and environment

The primary cilium, a hair-like sensory organelle found on most mammalian cells, has gained recent at-tention within the field of neuroscience. Although neural primary cilia have been known to play a role in embryonic central nervous system patterning, we are just beginning to appreciate their importance in the mature organism. After several decades of investigation and controversy, the neural primary cilium is emerging as an important regulator of neuroplasticity in the healthy adult central nervous system. Further, primary cilia have recently been implicated in disease states such as cancer and epilepsy. Intriguingly, while primary cilia are expressed throughout the central nervous system, their structure, receptors, and signaling pathways vary by anatomical region and neural cell type. These differences likely bear relevance to both their homeostatic and neuropathological functions, although much remains to be uncovered. In this review, we provide a brief historical overview of neural primary cilia and highlight several key advances in the field over the past few decades. We then set forth a proposed research agenda to fill in the gaps in our knowledge regarding how the primary cilium functions and malfunctions in nervous tissue, with the ultimate goal of targeting this sensory structure for neural repair following injury.     

Pathogenic analysis in different types of orthopedic implant infections

Background Diversity of orthopedic infections with various local environments affects the pattern and prevalence of pathogens.It is not well-characterized whether different pathogens have different propensity to cause different types of orthopedic infections.We aimed to investigate the frequency of different pathogens derived from orthopedic infections,and determine the relationship between the prevalence of clinical isolates and the type of orthopedic implants,especially focusing on staphylococci.Methods From January 2006 to December 2011,orthopedic infections were identified retrospectively from clinical microbiology laboratory and orthopedic medical records.The sources of orthopedic infections were divided into two main groups：those associated with implants and those not associated with implants.Implants-associated infections were further subdivided into five subgroups：arthroplasty,internal fixation,external fixation,internal and external fixation,and others.We analyzed microbiological spectrum in different groups and subgroups.Antibiotic susceptibility of staphylococci was analyzed.Results Only coagulase-negative staphylococci （CoNS） was significantly more likely to be associated with implantsassociated infections （P=0.029）.The overall pathogens prevalence of arthroplasty was significantly different from other subgroups （P 〈0.05）.65% isolates from external fixation was Gram-negative bacteria.Some percentage （55%） of S.aureus and （83%） CoNS were resistant to methicillin.No resistance to glycopeptide was seen in all of staphylococci.Conclusions Staphylococcus aureus was the most frequent isolates in orthopedic infections but was not associated with the presence or absence of implants.Only CoNS was implants-associated,especially for arthroplasty infection.Cefazolin alone is not enough for orthopedic surgery prophylaxis in settings with a high prevalence of methicillin-resistant staphylococci.     

A lithium-containing nanoporous coating on entangled titanium scaffold can enhance osseointegration through Wnt/β-catenin pathway

An entangled titanium wire porous (ETP) scaffold shows similar mechanical properties of cancellous bone and is a promising bone repair material. However, the ETP scaffold's inert biocompatibility and poor osteogenic ability limit its clinical application. In this study, a Li-containing nanoporous coating was added on ETP by micro-arc oxidation (MAO). The SEM results indicated that a hierarchical and compact coating was formed on the Li-MAO-ETP scaffold. In vitro cell tests showed improved osteoblast morphology, adhesion, and viability in the Li-MAO-ETP group. Moreover, the Li-MAO-ETP scaffold exhibited improved osteogenic differentiation properties by activating the Wnt/β-catenin signal pathway based on the western blotting and RT-PCR results. The push-out test, sequential fluochrome labeling, and toluidine staining demonstrated that the Li-MAO-ETP scaffold contained improved osteogenic ability in vivo. The in vitro and in vivo experiments showed that the Li incorporated entangled porous titanium could be a suitable biomaterial for bone defect repair.     

Crowe Ⅳ型髋关节发育不良患者全髋关节置换术下肢长度平衡的调节

目的 探讨Crowe Ⅳ型髋关节发育不良(DDH)全髋关节置换术(THR)中肢体长度平衡的调整原则及方法。方法 回顾性分析2009年7月—2012年6月行THR治疗的39例(41髋)Crowe Ⅳ型DDH患者的临床资料,根据双髋脱位情况对其进行分型,按分型设计并实施手术,分析随访结果。结果 根据双髋脱位情况分为4个亚型,其中Ⅰ型2例、Ⅱ型18例、ⅢA型6例、ⅢB型9例、 Ⅳ型4例。术前患者两下肢长度平均差异为5.1 cm, 术后为-1.4 cm。患者随访时间12～36个月平均22.4个月。最终随访的平均SF-12健康评分为16分(区间为13~22分)。结论 根据不同分型对Crowe Ⅳ型DDH患者设计个体化重建手术方案,按设计方案可有效调整下肢长度差异。     

Reevaluating Current Cutoffs for Acute Periprosthetic Joint Infection: Current Thresholds Are Insensitive

BackgroundDiagnosing acute periprosthetic joint infection remains a challenge. Several studies have proposed different acute cutoffs resulting in the International Consensus Meeting recommending a cutoff of 100 mg/L, 10,000 cell/μL and 90% for serum C-reactive protein (CRP), synovial white blood cell count (WBC), and polymorphonuclear percentage (PMN%), respectively. However, establishing cutoffs are difficult as the control group is limited to rare early aseptic revisions, and performing aspiration in asymptomatic patients is difficult because of a fear of seeding a well-functioning joint arthroplasty. This study (1) assessed the sensitivity of current thresholds for acute periprosthetic joint infection (PJI) and (2) identified associated factors for false negatives.MethodsWe retrospectively reviewed patients with acute PJIs (n = 218), defined as less than 6 weeks from index arthroplasty, treated between 2000 and 2017. Diagnosis of PJI was based on 2 positive cultures of the same pathogen from the periprosthetic tissue or synovial fluid samples. Sensitivities of International Consensus Meeting cutoff values of CRP, synovial WBC, and PMN% were evaluated according to organism type. Multiple logistic regression analysis was performed to determine associated factors for false negatives.ResultsOverall, the sensitivity of CRP, synovial WBC, and PMN% for acute PJI was 55.3%, 59.6%, and 50.5%, respectively. Coagulase-negative Staphylococcus (CNS) demonstrated the lowest sensitivity for both CRP (37.5%) and WBC (55.6%). CNS infection was identified as an independent risk factor for false-negative CRP.ConclusionsCurrent thresholds for acute PJI may be missing approximately half of PJIs. Low virulent organisms, such as CNS, may be responsible for these false negatives. Current thresholds for acute PJI must be reexamined.     

钢板髓外固定与髓内钉固定治疗股骨转子下骨折的比较研究

目的比较微创内固定系统(LISS)钢板髓外固定与髓内钉固定治疗股骨转子下骨折的手术方法与疗效。方法回顾性分析32例股骨转子下骨折患者资料,根据患者内固定方式分成髓内钉组(18例)和钢板组(14例),比较两组患者手术时间、出血量、骨愈合时间及Harris评分情况。结果髓内钉固定患者的出血量、骨愈合时间均明显少于LISS固定患者,差异有统计学意义(t分别=2.61、2.12,P均<0.05),且髓内钉固定患者6个月后Harris评分亦明显优于LISS固定患者,差异有统计学意义(χ2=4.23,P<0.05)。结论在治疗转子下骨折患者中,髓内钉固定的疗效可能优于LISS钢板固定。     

多囊卵巢综合征患者子宫内膜病理改变及雌,孕激素受体测定

目的观察多囊卵巢卵巢综合征（ＰＣＯＳ）患者子宫内膜病理改变及雌激素受体（ＥＲ）、孕激素受体（ＰＲ）改变。方法对３９例ＰＣＯＳ患者进行子宫内膜病理检查,采用免疫组化方法测定子宫内膜ＥＲ及ＰＲ,并以正常妇女作为对照。结果３４例（８７．２％）ＰＣＯＳ患者子宫内膜呈无排卵型,内膜增殖症发生率为５１．３％（２０／３９）,内膜腺体发育不同步为３５．９％（１４／３９）,内膜间质反应不良为４６．２％（１８／３９）。ＰＣＯＳ患者子宫内膜增殖期ＥＲ、ＰＲ较正常妇女增多（Ｐ＜０．０５）,内膜增殖症者间质ＰＲ减少（Ｐ＜０．０５）且分布不均匀。结论ＰＣＯＳ患者子宫内膜的病理改变和局部ＥＲ、ＰＲ减少或缺乏,可能是不孕的原因之一。     

PTEN regulation of local and long-range connections in mouse auditory cortex

Autism spectrum disorders (ASDs) are highly heritable developmental disorders caused by a heterogeneous collection of genetic lesions. Here we use a mouse model to study the effect on cortical connectivity of disrupting the ASD candidate gene PTEN (phosphatase and tensin homolog deleted on chromosome 10). Through Cre-mediated recombination, we conditionally knocked out PTEN expression in a subset of auditory cortical neurons. Analysis of long-range connectivity using channelrhodopsin-2 revealed that the strength of synaptic inputs from both the contralateral auditory cortex and from the thalamus onto PTEN-cko neurons was enhanced compared with nearby neurons with normal PTEN expression. Laser-scanning photostimulation showed that local inputs onto PTEN-cko neurons in the auditory cortex were similarly enhanced. The hyperconnectivity caused by PTEN-cko could be blocked by rapamycin, a specific inhibitor of the PTEN downstream molecule mammalian target of rapamycin complex 1. Together, our results suggest that local and long-range hyperconnectivity may constitute a physiological basis for the effects of mutations in PTEN and possibly other ASD candidate genes.     

机器人辅助下膝关节单髁置换术初步临床结果

目的 探讨机器人辅助下膝关节单髁置换术(UKA)能否提高手术的精准性,以及其安全性和短期疗效。方法 对2016年9—12月在上海交通大学附属第六人民医院和解放军总医院骨科关节外科接受机器人辅助下UKA治疗的20例患者临床资料进行回顾性分析。术前诊断均为膝关节骨关节炎,每家医院各10例患者;男3例,女17例;年龄51~79岁,平均65岁;BMI(26.9±3.4) kg/m²。均采用MAKO RIO机器人手术系统和RESTORIS MCK单髁膝关节假体(STRYKER MAKO Surgical,美国)进行手术,其中有5例患者同时接受双侧UKA。记录手术时间及出血量、术后疼痛情况,测量术前及术后下肢力线、术后胫骨假体植入角度,术前和术后进行膝关节功能评分。结果 单侧UKA手术术中止血带使用时间平均为(27±10) min。15例单侧单髁置换患者术后第2天时总失血量平均为(476±290)mL,无一例患者需要接受输血治疗。术后8、16和24 h VAS评分平均分别为(3.2±1.2)分、(1.8±0.8)分和(1.1±0.3)分。20例(25膝)患者均获得随访,随访时间为8~20周,平均14.1周。末次随访时,患侧膝关节的美国膝关节协会评分临床评分由术前的(57±13)分提高至(90±6)分,功能评分由术前的(48±18)分提高至(79±12)分,差异均有统计学意义(t=14.941、10.014,P值均<0.01);胫骨假体冠状位的植入角度为内翻0°~3.9°,平均1.7°±1.2°,与术前计划的目标角度(内翻1°)偏差0°~3°,平均为1.1°±0.9°。2家医院两组病例胫骨假体冠状位角度与目标位置的偏差分别为1.2°±1.1°和1.0°±0.6°,差异无统计学意义(t=0.421, P＞0.05)。随访期间所有病例均未观察到手术部位感染、深静脉血栓形成以及血管神经损伤等手术相关的并发症。结论 机器人辅助下UKA能够实现微创条件下的精准手术,并具有优异的安全性;其远期临床效果及对膝关节功能改善的作用,尚需进一步的对照研究和长期随访加以证实。