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Objective: To Explore the current status and risk factors of perioperative allogenic red blood cell transfusion following enhanced recovery hip and knee joint arthroplasty. Methods: Patients who have taken their primary unilateral total hip and knee arthroplasty (THA, TKA) or simultaneous primary THA were retrospectively included from January, 2019 to December, 2019 in West China Hospital. The baseline characteristics were compared between patients with allogeneic transfusion and those without. And logistic regression were used to analyze the risk factors of perioperative allogeneic red blood cell transfusion. Results: A total of 2 034 patients (2072 arthroplasties) were included, 705 males and 1 329 females, aged (60±24) years. Of all, 1 137 patients received primary THA (38 simultaneous THA), 897 patients received primary unilateral TKA. Eleven (0.54%) patients received allogeneic red blood cell transfusion, and the mean volume was (2.6±1.2) U. Deep venous thrombosis occurred in 2 patients (0.09%) undergoing primary TKA. The transfusion rate in primary THA patients was 0.79% (9/1 137), and 0.22% (2/897) in TKA. Lower preoperative hemoglobin level ( P =0.041) and more hematological comorbidities ( P =0.005) were detected in transfused patients. And logistic analysis further revealed that preoperative substandard hemoglobin level was the most important risk factor for transfusion ( OR =5.663, P =0.018). Conclusions: Under the intervention of enhanced recovery after surgery concept and modern blood management strategies, the transfusion requirement has been significantly reduced following primary joint arthroplasty. Pre-operative hemoglobin level should be an important threshold for perioperative blood management.

Objective: To investigate the potential of small interfering RNA (siRNA) against human peroxisome proliferator activated receptor gamma (PPARgamma) to suppress the adipogenic effect of alcohol on human bone marrow-derived mesenchymal cells (hBMSCs) and increase osteogenesis., Methods: hBMSCs collected from joint replacement surgery were cultured, passaged, and transfected with PPARgamma-siRNA by using liposomal-based strategy. Then the cells were maintained in culture and treated with alcohol 50 mmol/L and dexamethasone, an osteogenic inducer, for 24 days. Oil red O staining was used to observe the fat drops in the cells so as to count the number of adipocytes. Histochemistry was performed to detect the protein expression of alkaline phosphatase, osteocalcium, and type 1 collagen on days 24 and 28 after treatment. Real-time PCR and Western blotting were used to detect the mRNA and protein expression of osteoblast-specific transcription factor-2 (Osf2)/core-binding factor alpha subunit 1 (Cbfa1) on day 10., Results: The adipocyte number of the PPARgamma-siRNA group was significantly lower than those of the alcohol-induced group and the controls (adipogenic group, liposomal group, and negative siRNA group) (all P < 0.05). The Calcium nodule formation rate of the PPARgamma-siRNA group was significantly higher than alcohol-induced group and the controls (adipogenic group, liposomal group, and negative siRNA group) (all P < 0.05). PCR and Western blotting showed significantly higher mRNA and protein expression of the human adipocyte-specific markers:Cbfa1, ALP, type 1 collagen, and osteocalcin, than the other groups., Conclusion: The adipogenic effect of alcohol on hBMSCs can be inhibited with a concomitant increase in osteogenesis by using siRNA technique to specific targeted human PPARgamma gene in vitro cell culture systems. PPARgamma-siRNA strategy may be a useful tool for studying the mechanisms of alcohol-induced osteoporosis and provides theoretical basis for its genetic therapy.

Objective: To evaluate the effects of transplantation of human hepatocyte growth factor (hHGF) gene-modified osteoblasts combined with core decompression in treatment of avascular necrosis of femoral head (ANFH)., Methods: The plasmid pcDNA3.1(+)-hHGF containing hHGF gene was constructed. Osteoblasts were isolated from fetal rabbits, cultured, and transfect3d with the plasmid pcDNA3.1(+)-hHGF or blank plasmid pcDNA3.1(+), or used as controls. Thirty-six adult New Zealand rabbits were made into ANFH models, underwent core decompression, and were randomly divided into 3 groups. Group A, transplanted with osteoblasts transfected with pcDNA3.1(+)-hHGF plasmid, Group B, transplanted with osteoblasts not transfected with pcDNA3.1(+)-hHGF plasmid, and Group C, injected with PBS medium. 2, 4, and 8 weeks later samples of femoral head were obtained to undergo CT, histological examination, and capillary ink infusion so as to observe the angiogenesis and osteogenesis., Results: The pcDNA3.1(+)-hHGF transfected osteoblasts showed stable expression of hHGF. The numbers of newly formed vessels of the femoral heads of the group transfected with pcDNA3.1(+)-hHGF-transfected osteoblasts 2 and 4 weeks later were (29.47 +/- 1.64) and (34.02 +/- 1.72)/cm2 respectively, both significantly higher than those of the group transfected with blank plasmid-transfected osteoblasts [(20.61 +/- 1.91) and (25.57 + 2.20)/cm2 respectively, both P <0. 01]. Eight weeks later the numbers of mature trabecular bone and bone marrow of Groups A and B were significantly higher than those of Group C., Conclusion: Core decompression combined with transplantation of HGF gene-modified osteoblasts promotes angiogenesis, enhances bone formation, and improves the restoration of avascular necrosis of femoral head.

Objective: To explore the relationship between the alterations of platelet-derived microparticles (PMPs) and endothelial cell-derived microparticles (EMPs) and steroid-induced osteonecrosis of the femoral head., Methods: Forty-four adult Japanese white rabbits were randomly divided into 2 groups: experimental group (n = 44), injected intramuscularly once with 20 mg/kg of methylprednisolone acetate, and control group (n = 28) injected with normal saline of the same dose. Blood samples were collected from the auricular vein while the animals were in a fasting state in early morning prior to experiment (week 0), and 2, 4, and 8 weeks after the injection. The levels of prothrombin time (PT), activated partial prothrombin time (APTT), and anti-thrombokinase-III (AT-III) were examined. Plasma was ultra-centrifuged and the circulating platelet and EMPs were isolated to undergo flow cytometry to detect the amounts of CD31, CD42a, CD54, and CD62E. 1, 2, 4, and 8 week after the injection 6 rabbits from the experimental group and 4 rabbits from the control group were sacrificed respectively and their femoral heads were taken out to undergo histopathologic examination with HE staining and microthrombus and elastic fiber staining., Results: The PT, APTT, and AT-III levels increased significantly 1 to 8 weeks after the injection. The numbers of EMPs and PMPs were also increased markedly after steroid administration. Histopathologic examination demonstrated an accumulation of bone marrow cell debris, presence bone empty lacunae in the trabeculae 1 week after the steroid injection. 2, 4, and 8 weeks after the steroid injection the bone necrosis was remarkable, fatty degeneration of bone marrow cells occurred, the diameter of fat cells increased, and the area ratio of fatty cells became higher. MSB staining was positive., Conclusion: High dose glucocorticosteroid increases the levels of PMPs and EMPs that may be related to hypercoagulability and thrombosis in microcirculation and play an important role in steroid-induced osteonecrosis. MP can be considered a true target in the pharmacological control of steroid-induced osteonecrosis.

Objective: To discuss the method of reconstruction of acetabular bone defect with wire mesh, impaction bone-grafting and a cemented cup in acetabular component revision., Methods: 21 hips in 21 patients, aged 50.1 (31 - 64), 2 hips being of the acetabular defect type I B, 1 hip of type II A, 4 hips of type II B, and 14 hips of type III according to the American Academy of Orthopaedic Surgeons (AAOS) grading system underwent reconstruction with wire mesh, impacted bone grafts and cemented polyethylene acetabular component, and then were followed up for 47 months (36 - 60 months)., Results: The mean Harris hip score improved from the preoperative 55.7 points to 92.9 points at the last time of follow-up. Radiographic incorporation between host the bone and allograft was achieved 11.4 months after the operation on average. The mean change of inclination of acetabular components was 2.2 degrees , in which one acetabular component developed a change of 15.5 degrees . The inclination of acetabular components increased by 1.7 degrees on average 3 months after the operation and 2.0 degrees 6 months after the surgery. The acetabular cup migrated medially and superiorly by 3.93 mm and 4.41 mm respectively, peaking in the sixth month after the operation. One hip developed heterotopic ossification (Brooker grade I). One hip received repeat revision because of the aseptic loosening of the acetabular component 25 months after the revision surgery., Conclusion: The changes of the position of acetabular cup mainly occur within six months after the reconstruction of severe acetabular bone defect with wire mesh, impacted bone graft and cemented polyethylene acetabular component. To prevent the displacement of the acetabular cup, it is necessary to keep initial stability of the acetabular cups within six months after the index surgery.

Objective: To observe the effects of basic fibroblast growth factor (bFGF) on neuronal apoptosis and caspase 3 gene expression after spinal cord injury., Methods: Forty-five SD rats were randomly divided into 3 equal groups: normal group (n = 5, with the spinal cord intact), treatment group [n = 20, with their spinal cord at T13-L2 injured by distraction till the cortical somatosensory evoked potential (CSEP) decreased by 70% and then a thin plastic tube inserted into the subarachnoid cavity below the injured level for perfusion of bFGF 20 microg immediately, and 1, 2, 3, 4, 8, 12, and 24 hours after injury], and control group (n = 20, with their spinal cord at T13-L2 injured by distraction till the CSEP decreased by 70% and then a thin plastic tube inserted into the subarachnoid cavity below the injured level for perfusion of normal saline of the same volume at the same time points). CSEP was tested by electrophysiological technique to record the latent time of P1 wave and the amplitude of P1-N1. Combined behavioral score (CBS) was used to evaluate the function of spinal cord, including motivation, sensation, reflex, and coordination of actions. The rats were killed at the days 1, 4, 7, 14, and 21 postoperatively. A segment of spinal cord T13-L2 1.5 cm long was taken out to be fixed and sliced. Flow cytometry was used to detect the neuronal cell apoptosis. Imunohistochemistry and TUNEL were used to examine the expression of caspase 3., Results: The CBS value of the normal group was 0, and the CBS values at different time points of the treatment group were all lower than those of the control group (P < 0.05 or P < 0.05). The values of latent time of P1 wave 4 approximately 21 days after injury of the 2 injury groups were all longer than that of the normal group, those of the treatment group being significantly shorter than those of the control group. The values of P1-N1 amplitude 4 approximately 21 days after injury of the 2 injury groups were all lower than that of the normal group, those of the treatment group being significantly lower than those of the control group (P < 0.05 or P < 0.01). TUNEL showed that the apoptotic cell numbers at different time points of the 2 injury groups were lower than that of the normal group, those of the treatment group being significantly lower than those of the control group (P < 0.05 or P < 0.01). Immunohistochemistry showed that the numbers of caspase 3 positive cells at different time points of the 2 injury groups were all lower than that of the normal group, those of the treatment group being significantly lower than those of the control group (P < 0.05 or P < 0.01). The active fluorescence values at different time points of the 2 injury groups were all higher than those of the normal group, those of the treatment group being significantly lower than those of the control group (P < 0.05 or P < 0.01)., Conclusion: bFGF inhibits the expression of caspase 3 protein, reduces the caspase 3 activity, lessens the secondary cell apoptosis in the injured spinal cord, and promotes nerve function recovery of spinal cord.