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Background: Major symptoms of depression are commonly observed in patients requiring total hip arthroplasty (THA), and this is associated with increased pain scores and opioid consumption. We aimed to investigate the analgesic effect of duloxetine in these high-risk patients.Methods: Among 263 patients scheduled for primary unilateral THA, 67 patients who scored at least 8 on the 17-item Hamilton Depression Scale (HAMD) were enrolled in this study. Patients were randomized to the duloxetine group (60 mg daily, from the day of surgery to postoperative day 6) or the placebo group. The postoperative visual analog scale (VAS) score during walking, the VAS score during hip flexion, and resting VAS score was measured. Postoperative morphine consumption, hip range of motion (ROM), Harris hip score (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) function, postoperative length of stay (LOS), and adverse events were recorded.Results: The duloxetine group had significantly lower VAS scores during walking and hip flexion from postoperative day 3 to week 3 than the placebo group. With regard to the resting VAS score, duloxetine showed a better analgesic effect from postoperative day 3 to week 2 than placebo. Patients in the duloxetine group had less consumption of morphine. The duloxetine group exhibited better hip function scores, including ROM, HHS, and WOMAC function scores than the placebo group. No significant difference was observed in LOS or adverse events between groups.Conclusion: Perioperative short-term duloxetine provides advantages in decreasing pain, reducing morphine consumption, and increasing hip function in THA patients who have depressive symptoms. [ABSTRACT FROM AUTHOR]

Background: This study aimed to explore the analgesic effect among adductor canal block (ACB) combined with infiltration between the popliteal artery and the capsule of the posterior knee (IPACK) block, ACB, and IPACK block following total knee arthroplasty (TKA).Methods: One hundred twenty patients were randomly allocated into 3 groups including group A (ACB + IPACK block), group B (ACB), and group C (IPACK block). The primary outcome was postoperative pain score. The secondary outcome was opioid consumption. Other outcomes included functional evaluation and postoperative complications.Results: Group A showed the lowest pain scores within 8 hours at rest and with knee maximum flexion (P < .001). From 12 to 24 hours, group C showed the highest pain scores, while no significant difference was found between group A and group B. No significant difference was found among the 3 groups 24 hours postoperatively. Group C showed the most opioid consumption within the first 24 hours and during the hospitalization, while no significant difference was found between group A and group B. No significant difference was found among the 3 groups including function evaluation and postoperative complications.Conclusion: ACB + IPACK block can improve early analgesia when compared with ACB. However, the small statistical benefit to the addition of IPACK block to ACB may be unlikely to be clinically significant. Further studies may focus on patient selection and how to prolong the effect of IPACK block. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study is to analyze the 10-year outcomes of cementless, modular total hip arthroplasty (THA) in adult patients who had high dislocation secondary to childhood pyogenic arthritis.Methods: We retrospectively followed 56 consecutive patients who underwent cementless, modular THA for the late sequelae of childhood septic arthritis of the hip from 2001 to 2011. There were 23 men and 33 women with a mean age of 47 years (24 to 68). Of the 56 hips, 25 were classified as Crowe type III and 31 as type IV. Mean follow-up was 10.7 years.Results: One hip with a quiescent period of 23 years had recurrence of infection. Revision surgery was performed in 2 patients because of loosening and breakage of femoral stem and new infection with no correlation with childhood sepsis, respectively. The mean Harris hip scores improved from 44.2 points preoperatively to 87.5 points at final follow-up. Similarly, the Hip dysfunction and Osteoarthritis Outcome Score and hip pain also significantly improved at the latest follow-up. The mean acetabular cup abduction was 40.8° and the mean anteversion 27.8°, respectively. There were 5 cases of transient nerve palsy and 5 cases of intraoperative fracture.Conclusion: THA can reliably restore the abnormal anatomy and provide good results in these young and active patients who had high hip dislocation secondary to childhood pyogenic arthritis with a relatively high incidence of complications. However, these complications can be treated. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to evaluate the influence of total hip arthroplasty on axial alignment of the lower limb in adults with unilateral developmental hip dysplasia (Crowe type IV).Methods: We retrospectively reviewed medical records of 50 adults who underwent total hip arthroplasty, in which the acetabular cup was placed in the anatomical position. The following parameters were measured before surgery, immediately after surgery, and two years later: mechanical axis deviation (MAD), tibiofemoral angle (TFA), femoral offset, hip-knee-ankle angle (HKA), mechanical lateral distal femoral angle (LDFA), mechanical medial proximal tibial angle, height of medial femoral condyle, height of lateral femoral condyle, and leg lengthening. Length of the resected femoral segment was also recorded from medical records.Results: Preoperative MAD, TFA, HKA, and LDFA of the ipsilateral lower limb showed significant valgus deformity. MAD of the ipsilateral lower limb and valgus inclination were significantly smaller immediately after surgery than before, while TFA, HKA, femoral offset, and LDFA were significantly larger (P < 0.05). These parameters did not differ significantly between immediately after surgery and two years later (P > 0.05). Ipsilateral extremities were extended by a mean of 2.54 cm (range, 0 to 5.35 cm). The mean length of the femoral resected segment was 3.56 cm (range, 2.03 to 5.74 cm). The contralateral lower limb showed marginally smaller MAD and medial proximal tibial angle after surgery than before, but larger LDFA, TAF, and HKA.Conclusions: In patients with developmental hip dysplasia who underwent total hip arthroplasty with placement of the acetabular component at the level of the anatomic hip center, axial alignment of the ipsilateral lower limb was immediately altered, and valgus inclination was significantly reduced. The procedure only slightly altered the axial alignment of the contralateral lower limb. [ABSTRACT FROM AUTHOR]

Background: Tranexamic acid (TXA) has demonstrated efficacy in reducing blood loss, reduction in hemoglobin, and blood transfusion requirements in primary total hip arthroplasty (THA). The optimal mode of TXA administration for patients undergoing primary THA is unclear. The purpose of this randomized controlled trial is to determine whether oral administration of TXA was superior to intravenous or topical routes in these patients.Methods: In this double-blinded, placebo-controlled trial, patients undergoing primary THA were randomized to oral (2 g TXA orally 2 hours preoperatively), intravenous (20 mg/kg intravenous TXA bolus 5 minutes before the incision), or topical (2 g TXA applied topically) TXA groups. The primary outcome was the reduction in hemoglobin. Secondary outcomes included blood loss, transfusion rate, cost of TXA (Chinese yuan (¥); in 2017, ¥1 = $0.147), and adverse events.Results: One hundred eighty patients were randomized into the 3 groups. Demographic characteristics were similar among the groups. The mean reduction in hemoglobin was similar among the oral, intravenous, and topical groups (3.48 ± 1.32, 3.58 ± 1.07, and 3.66 ± 1.26 g/dL, respectively). Similarly, the mean total blood loss did not differ significantly among the 3 groups. The oral group incurred the lowest TXA cost (¥480) compared with that in the intravenous (¥3329.28) and topical (¥3540) groups (P = .01). None of the patients sustained a deep venous thrombosis, pulmonary embolism, or an infection.Conclusion: The blood-sparing efficacy of oral TXA is comparable to that of the intravenous and topical forms. Oral TXA is recommended because of its cost-benefit superiority and ease of administration. [ABSTRACT FROM AUTHOR]

Background: Given the lack of studies of acetabular defect reconstruction in primary total hip arthroplasty (THA) using tantalum augments, this study aims to evaluate clinical and radiographic results for treatment with tantalum augments to reconstruct acetabular defects in primary THA.Methods: We retrospectively reviewed 19 patients (19 hips) with acetabular defects who underwent primary THA using tantalum augments, with a minimum follow-up of 2 years. Clinical, radiographic, and surgical data were retrospectively evaluated.Results: Mean follow-up was 5.1 years (range 2.5-7.6). Harris Hip Score improved from 35.8 (range 19-56) preoperatively to 85.3 (63-98) at last follow-up (P < .01). Oxford Hip Score, University of California Los Angeles activity scale, and Short Form-12 score also improved significantly from presurgery to last follow-up. Mean operation time and blood loss were 124.7 minutes and 530 mL, respectively. Mean hip center position was 2.97 cm (range 2.35-3.58) horizontally and 2.06 cm (1.29-2.92) vertically, and mean acetabular inclination was 38.9° (range 27°-47°) at last follow-up. These parameters were not significantly different from those recorded immediately postoperatively (P > .05). There was no aseptic loosening, cup and augment migration, screw breakage, or presence of hip infection at last follow-up. All hips were radiographically stable.Conclusion: Porous tantalum augments combined with titanium shells lead to satisfactory clinical and radiographic outcomes for the reconstruction of acetabular defect in primary THA at a mean 5.1 years of follow-up. This approach confers anatomical cup placement, simple operation, and a high rate of stable fixation. [ABSTRACT FROM AUTHOR]

Objective To investigate the changes of serum leptin, lipid levels, adiponectin, NO and TNF-α in patients withnon-traumatic ischemic necrosis of the femoral head of the femoral head and its meanings. Methods A total of 80 patients with ischemic necrosis of the femoral head were selected from January 2015 to January 2016. And 30 healthy volunteers who took the same time were selected as the control group. Both subjects were given venous blood in the morning fasting. Serum leptin levels were measured by radioimmunoassay. Serum lipids, high and low density lipoprotein, cholesterol, triglyceride and apolipoprotein A1 were detected by automatic biochemical analyzer. Apolipoprotein B was measured by radioimmunoassay. The levels of serum adiponectin were measured by radioimmunoassay. The levels of NO and TNF-α in serum were measured by enzyme-linked immunosorbent assay (ELISA). Results Compared with the control group, the levels of cholesterol, triglyceride level, middle and low density lipoprotein and apolipoprotein B were significantly increased in INFH serum; the levels of high density lipoprotein and apolipoprotein A1 were significantly decreased The contents of NO and TNF-α were significantly increased, the content of adiponectin was significantly decreased. There was significant difference between the two groups ( P  < .05). Conclusion The levels of serum cholesterol, triglyceride level, low density lipoprotein level, apolipoprotein B level, leptin, NO and TNF-α levels in serum of INHF patients were positively correlated with the condition of INHF patients, and high density lipoprotein levels, Apolipoprotein A1 levels and adiponectin levels were negatively correlated with INHF patients. [ABSTRACT FROM AUTHOR]

Background: When surgeons reconstruct hips with a high dislocation related to severe developmental dysplasia of the hip (DDH) in total hip arthroplasty (THA), archiving long-term stable implant fixation and improving patient function and satisfaction remain challenging. The purpose of this study was to evaluate the 10-year outcomes of transverse subtrochanteric shortening osteotomy in cementless, modular THA in Crowe type IV-Hartofilakidis type III DDH.Methods: We reviewed 62 patients (76 hips) who underwent cementless THA with transverse subtrochanteric shortening osteotomy from 2002-2010. There were 49 women and 13 men with a mean age of 38.8 years, all of whom had Crowe type IV DDH. Mean follow-up period was 10 years. The acetabular cup was implanted in placement of the anatomical hip center in all hips.Results: The mean Harris Hip Score significantly improved from 38.8 points to 86.1 points. Similarly, modified Merle d'Aubigne and Postel Hip Score, Hip dysfunction and Osteoarthritis Outcome Score, and SF-12 also significantly improved. The mean limb length discrepancy was reduced from 4.3 cm to 1.0 cm. At mean follow-up of 10 years, there were 3 cases of postoperative dislocation, 2 cases of transient nerve palsy, 1 case of nonunion, and 4 cases of intraoperative fracture. Revision surgery was performed in 2 patients due to isolated loosening of acetabular component and femoral stem, respectively.Conclusion: Our data demonstrated that the cementless, modular THA combined with transverse subtrochanteric shortening osteotomy was an effective and reliable technique with high rates of successful fixation of the implants and satisfactory clinical outcomes. [ABSTRACT FROM AUTHOR]

The Kongling Terrane, which is the Archean nucleus of the Yangtze craton, preserves Paleoarchean-Proterozoic rocks as old as 3.45 Ga. However, the dominant stage of formation of this Archean terrane remains unclear. In this paper, U-Pb and Lu-Hf isotopes of detrital zircons from two rivers and one stream in the northern part of the Kongling Terrane were studied by LA-ICP-MS and LA-MC-ICP-MS, respectively. These zircons show complicated internal structures in cathodoluminescence images, but the majority of them have linear or oscillatory zoning patterns, indicating magmatic origins. In general, the detrital zircons from these three local rivers show similar U-Pb age distributions. Together, they yield age peaks at 3.3–3.1 Ga (5%), 3.0–2.8 Ga (18%), 2.7–2.6 Ga (30%), 2.6–2.2 Ga (15%), 2.0–1.9 Ga (27%), 1.9–1.7 Ga (1%), 1.7–1.5 Ga (2%), and 1.0–0.8 Ga (1%). This age distribution implies that the North Kongling Terrane formed primarily during the Meso- to Neoarchean (3.0–2.6 Ga). Lu-Hf isotopic data reveal predominant subchondritic to chondritic ε Hf (t) values (− 11.3 to 0) for the Mesoarchean zircons, indicating the dominant role of crustal reworking during this period. In comparison, most Neoarchean zircons exhibit near chondritic to suprachondritic ε Hf (t) values (up to + 7.4), suggesting juvenile crustal additions. The 2.0–1.9 Ga zircons have similar initial Hf isotopic compositions as those of the 2.7–2.6 Ga zircons, suggesting a metamorphic recrystallization origin. This observation further implies that the proportion of Neoarchean ages might be underestimated. Previous studies have reported several 2.7–2.6 Ga Archean outcrops, minor detrital zircons in Precambrian sedimentary rocks and xenocrystal zircons in volcanic rocks from the Yangtze craton. Combined with our data, we propose that the 2.7–2.6 Ga magmatism may have played an important role in forming the Kongling Terrane and have widely affected other parts of the Yangtze craton as well, similar to many other Archean cratons worldwide. The ~ 2.7–2.6 Ga may correspond to the initial stabilization of the Archean nucleus of the Yangtze craton. Thereafter, this craton shows comparable 2.5–2.2 Ga age records to the recently proposed Nunavutia supercraton, which could provide further clues to the early tectonic process of the Yangtze craton. [ABSTRACT FROM AUTHOR]

Abstract: Our aim was to investigate the changes in bone mineral density (BMD) of acetabulum and proximal femur after total hip resurfacing arthroplasty. A comparative study was carried out on 51 hips in 48 patients. Group A consisted of 25 patients (26 hips) who had undergone total hip resurfacing and group B consisted of 23 patients (25 hips) who had had large-diameter metal-on-metal total hip arthroplasty (THA). BMDs around the acetabulum and proximal femur were measured using dual-energy x-ray absorptiometry (DEXA) at 2weeks, 6months, 1year and annually thereafter during the 3years after surgery. At final follow-up, the acetabular net mean BMD decreased by 11% in group A and 10% in group B with no differences between two groups (P =.35). For the femoral side, in Gruen zone 1, the mean BMD increased by 4% in group A, whereas it decreased by 11% in group B (P =.029). In Gruen zone 7, the mean BMD increased by 8% at the final follow-up in group A, whereas it decreased by 13% in group B (P =.02). In both groups the mean BMD increased by 3% in Gruen zones 3, 4, 5, and 6. Stress-related bone loss of the acetabulum was comparable for MOM THA and resurfacing devices, but proximal femoral bone density increased in the resurfacing group and decreased in the THA group. [Copyright &y& Elsevier]

Abstract: This study was designed to evaluate the midterm results of hybrid total hip arthroplasty in a consecutive series of 45 Chinese patients with osteoarthritis secondary to dysplastic hip. The average follow-up was 6.6 years. A total of 24 hips were classified as dysplasia, 20 hips as low dislocation, and 13 hips as high dislocation. The preoperative Harris score was 46.19 ± 18.01, which improved to 91.78 ± 3.52 at the final follow-up. The rate of polyethylene liner wear was 0.27 mm/y. Osteolysis was identified around 5 acetabular components and 13 femoral components. With the use of loosening or revision as the end point for failure, the survival rate was 1.0. We suggest that hybrid total hip arthroplasty in Chinese developmental dysplasia of hip patients has favorable results at midterm follow-up, even though their lifestyle includes more deep flexion of the hip. There is no significant difference of postoperative Harris score with increasing severity of dysplasia. [Copyright &y& Elsevier]

Highlights: [•] The Kuluketage and Dunhuang Blocks have a uniform Precambrian basement within the Tarim Craton. [•] An important episode of crustal growth at ∼2.0Ga occurred in the Tarim Craton. [•] The ∼1.85Ga magmatic event in the Tarim Craton was related to the assembly of the Columbia supercontinent. [•] The ∼1.75Ga magmatism was formed in a post-collisional tectonic setting. [Copyright &y& Elsevier]

[Display omitted] • miR-194 targets PHLDA1 in hepatic IRI. • PHLDA1 facilitates TRAF6 ubiquitination. • C25-140 reverses function of PHLDA1. Hepatic ischemia/reperfusion injury (IRI) is an inevitable pathological process in liver resection, shock and transplantation. However, the internal mechanism of hepatic IRI, including inflammatory transduction of multiple signaling pathways, is not fully understood. In the present study, we identified pleckstrin homology-like domain family member 1 (PHLDA1), suppressed by microRNA (miR)-194, as a critical intersection of dual inflammatory signals in hepatic IRI. PHLDA1 was upregulated in hepatic IRI with a concomitant downregulation of miR-194. Overexpression of miR-194 diminished PHLDA1 and inhibitors of the nuclear factor kappa-B kinase (IKK) pathway, thus leading to remission of hepatic pathological injury, apoptosis and release of cytokines. Further enrichment of PHLDA1 reversed the function of miR-194 both in vivo and in vitro. For an in-depth query, we verified PHLDA1 as a direct target of miR-194. Notably, inflammatory signal transduction of PHLDA1 was induced by activating TNF receptor-associated factor 6 (TRAF6), sequentially initiating IKK and mitogen-activated protein kinase (MAPK), both of which aggravate stress and inflammation in hepatic IRI. In conclusion, the miR-194/PHLDA1 axis was a key upstream regulator of IKK and MAPK in hepatic IRI. Targeting PHLDA1 might be a potential strategy for hepatic IRI therapy. [ABSTRACT FROM AUTHOR]

[Display omitted] • KGN loaded in MPDA was first successfully synthesized and shown release KGN upon NIR. • KGN@MPDA-PCM not only improved chondrogenic differentiation but also inhibited the hypertrophic differentiation of MSCs. • KGN@MPDA-PCM induced the expression of cellular Fn1 and then activated the PI3K/Akt pathway to promote the chondrogenic differentiation. • The material provided an effective repair strategy in vivo for cartilage injury. Improving chondrogenic differentiation while inhibiting hypertrophic differentiation of mesenchymal stem cells (MSCs) is of vital importance to effectively repairing cartilage injury. Accordingly, kartogenin (KGN) and antioxidants, which promote chondrogenic differentiation and inhibit hypertrophic differentiation, respectively, have shown great potential in promoting cartilage repair. However, KGN is poorly soluble in water, hindering efficient intracellular delivery. Near-infrared light (NIR)-responsive mesoporous polydopamine nanoparticles (MPDA) reportedly exert antioxidative effects by eliminating reactive oxygen species (ROS). In this study, we assessed whether KGN loaded in MPDA can accelerate cartilage injury repair in rats. Specifically, a thermosensitive phase-change material (PCM, melting point 39 °C) combined with KGN was loaded into MPDA as a gatekeeper (KGN@MPDA-PCM). The results showed that KGN@MPDA-PCM exhibited excellent photothermal properties under NIR irradiation, which induced PCM melting and consequent KGN release. In combination with antioxidative therapy, NIR-triggered KGN release enabled the nanocomposite to accelerate MSC chondrogenic differentiation and inhibit hypertrophic differentiation. Importantly, negligible damage to primary organs and satisfactory biocompatibility were observed in the rat model. RNA sequencing found that this MPDA-based platform promotes chondrogenic differentiation by promoting fibronectin-1 (Fn1) expression and activating the PI3K/Akt pathway. Collectively, these findings highlight the therapeutic potential of this MPDA-based platform for accelerating cartilage injury repair. [ABSTRACT FROM AUTHOR]

Purpose To compare the efficacy of multiple doses of oral tranexamic acid (TXA) with topical TXA administration in reducing blood loss following total hip arthroplasty (THA). Patients and methods In this double-blinded trial, 117 patients undergoing primary THA were randomized to receive 2 g TXA orally 2 h preoperatively, and two doses of 1 g TXA postoperatively (oral group) or 3 g of TXA topical administration in the operating room (topical group). The primary outcome was a reduction in hemoglobin concentration. Other outcomes—such as blood loss, TXA-related cost (¥), length of hospital stay (days), complications such as pulmonary thromboembolism (PE), deep vein thrombosis (DVT), and infection, blood coagulation and fibrinolysis, and hip function—were recorded. Results The mean reduction in hemoglobin level was similar between the oral and topical groups (3.07 g/dL compared with 3.12 g/dL; p = 0.85). Similarly, there was no significant difference in the mean total blood loss between oral and topical administration (863 mL compared with 902 mL; p = 0.62). Three patients received an allogeneic blood transfusion, including one patient in the oral group and two patients in the topical group (p = 0.55). The oral group had a significantly lower TXA-related cost than the topical group: ¥944 and ¥4359, respectively (p = 0.01). No PE, DVT, cardiac infarction or renal failure occurred during the 90-day follow-up. The coagulation and fibrinolysis parameters were similar between the two groups. Conclusion Oral TXA is equivalent to topical TXA administration in the reduction of blood loss in the setting of primary THA without drainage. [ABSTRACT FROM AUTHOR]

Early Neoproterozoic granitic gneisses are known from several locations such as the Xingxingxia, Alatage and Baluntai areas in the Central Tianshan Arc Terrane of the Chinese Eastern Tianshan, which is one of several Precambrian microcontinents within the southern Central Asian Orogenic Belt (CAOB). The petrogenesis and the tectonic significance of the early Neoproterozoic granitic gneisses have not been well constrained yet, resulting in an ambiguous understanding of the early tectonothermal evolution of the Chinese Eastern Tianshan. Geochronological results suggest that the protoliths of these granitic gneisses formed during a relatively short time period between ca. 970 and 915 Ma, mainly clustering at ca. 940 Ma. These peraluminous to strongly peraluminous granitic rocks show a common geochemical S-type granite affinity, involving low CaO, Na 2 O, Th and Y contents. Zircon saturation thermometry and Ti-in-zircon thermometry yielded a relatively low crystallization temperature of approximately 750–800 °C for the magmatic protolith of the granitic gneisses. Zircon Hf isotopic compositions of the Xingxingxia and Alatage granitic gneisses show ε Hf ( t ) values of −5.4 to 4.2, with T DM2 model ages of 1.53–2.14 Ga, indicating that their protoliths were derived by the recycling of older continental crust. We suggest that the early Neoproterozoic granitic rocks in the Chinese Eastern Tianshan were formed along an active continental margin. Furthermore, we propose that the Central Tianshan Arc Terrane was located at the periphery of Rodinia and separated from the Tarim Craton terrane in the early Neoproterozoic. [ABSTRACT FROM AUTHOR]